There Are Several Dozens Posts on BPD At This Site
Bipolar Disorder(BPD) has been dealt with by a number of people at this site. I hope to provide a more longitudinal survey of my experience in the hope that it may help others at this site. People with mental illness bring to this site a special set of needs in the fitness world and a special set of skills to deal with them. If for some reason my series of posts, instalments, are seen as too long--I am happy to edit them -Ron Price, Tasmania
_____________________INSTALMEN T #1________
AN ACCOUNT OF MY 65 YEAR BIPOLAR DISORDER
A CONTEXT
October 1943 To January 2008
BY
RON PRICE
George Town Tasmania Australia
1. Preamble and Introduction:
This is both a longitudinal account, going back to my conception in October 1943, and a short term account taking in my most recent experiences in the last nine months(4/07-1/08)with manic-depression(MD) or bipolar disorder(BPD) as it has come to be called in recent years. Some of the personal context for this illness over the lifespan in my private and public life, in the relationships of my family of birth and of marriage, of work and now of retirement are discussed in this document. I also include some discussion of: (a) my personal circumstances as they relate to my values, beliefs and attitudes on the one hand--what some might call my religion as defined in a broad sense--and (b) my wife’s illness and my/our many moves and activities over the years on the other. This lengthy account should provide: (i) mental health sufferers, clients or consumers, as they are now variously called these days, with an adequate information base to make some comparisons and contrasts with their own situation, their own predicament whatever it may be, and thereby gain some helpful knowledge and understandings; and (b) those assessing my suitability for work or for public or private office with a useful document for making their decision about my capacity to take on the task/responsibility an informed one.
1.2 Many do not feel comfortable going to doctors, to psychologists and/or to psychiatrists. Perhaps this is part of a general distrust of certain professional fields in our world today. Perhaps it is part of a general public being more critical. Still others do seek help; others try to work things out themselves and there are, of course, various combinations of the two approaches. Many often find the journey through the corridors of mental health problems so complex, such a labyrinth, that they give up in despair. Suicide is common among the group I refer to here—the sufferers from MD and BPD. This account may help such people obtain appropriate treatment and, as a result, dramatically improve their quality of life. I think, too, that this essay of nearly 19,000 words and forty-seven A-4 pages(font 14) is part of: (a) my own small part in reducing the damaging stigma associated with BPD and (b) what might be termed "my coming out."
The wider context of my experience which I outline here is intended to place my BPD in context and should provide others with what I hope is a helpful perspective, as I say above, in relation to their own condition, their own problems and situations. This essay, as I say, of forty-seven A-4 pages(font-14) is written: (a) for doctors and various medical professionals who have dealt with or will come to deal with my disorder and who are now, at this present time, involved with my treatment, (b) for internet sites and those registered/inquirers on the www at a range of health and mental health sites, especially the sections of sites dealing with depression(D), MD and BPD, (c) some of my relatives, friends and associations over the years with whom I still have contact in these years of my late adulthood(60-80) and to whom it seemed relevant to give such a statement; (d) for government departments, voluntary organizations, interest groups and Baha’i institutions who require such statements for reasons associated with our relationships and interactions; and (e) for myself as a reflection, for my own satisfaction, to put into words the story, the results, of an illness, a sickness, a disorder that has influenced my life for over six decades.
This document, this statement, originally written as a first edition in 2003 has been revised many times after further reflection. Now in its third edition and the 17 draft of that 3rd edition, after feedback from various doctors, friends and internet respondents and after an increase in my own knowledge of the illness as a result of further study, this document is an ongoing and changing entity as my experience of the disorder continues into my sixties.
I do not claim to possess a specialized and/or professional expertise in the field of the study and treatment of D, MD or BPD. I do not work with people who have such problems, nor do I have a desire to do so, except as a participant at a number of internet sites concerned with relevant mental health topics and with people who cross my path serendipitously with various related problems. This long piece of writing, too long for some perhaps for most, not as sharply focussed on my actual experience as some respondents on the internet have already indicated and not particularly relevant to the experience of others in an illness that has a very wide range of behavioural typicalities, is but one of my many pieces of my writing these days. The vast majority of my writing has nothing to do with this disorder.
1.6 After more than 60 years of dealing with this medical problem in my private and public life, I would be only too happy to put it to bed, to put it into some final corner and forget it. Sadly, or perhaps fortuitously, I can not do so because I still suffer, even after 60 years, with problems that are part of this disorder’s long history in my life. I have also become more conscious, as I have come out in the last few years, of how this statement has come to be of great help to many, especially at the 75 mental health sites on the Internet where I place all or parts of this document.
1.7 I have italicized some of the more important sections toward the end of this document to assist those who are busy and not inclined to read a long statement like this. This italicization will assist such readers in: (a) making whatever assessment they need to make of this account, (b) finding out whatever information they desire that is relevant to their particular situation and (c) deciding what my present psycho-emotional state is in order to understand why I do not want to: (1) be employed/work in some job, (2) serve in some volunteer organization or (3) take on some task, some apparently simple activity, that I have been asked to take on.
2. My Experience of Manic-Depression: Phase One--The First 37 Years 1943 To 1980
2.1 In the first 37 years of my life I had many episodes of various kinds of emotional imbalance or disorientation, themselves of varying lengths and intensities, ranging from a euphoric, impetuous, expansive or high mood to a depressed, gray, low energy or despondent mood. Indeed the range of mood in these 37 years was much more extreme than that indication in this last sentence, but the complete/extreme range was rarely experienced. Sometimes these symptoms affected my day-to-day life severely and negatively and sometimes the affect was non-existent, insignificant, hardly noticeable. After many experiences on the fringe of a normality that was my usual modus operandi or modus vivendi, as it is said in Latin, on the fringe of what I saw as my general everyday experience of life, an experience that is sometimes called the quotidian by writers, poets and novelists, I was diagnosed as a MD in May 1980.
___________INSTALMENT #2 at later date________________________:c ool:
__________________
married for 42 years, a teacher for 35 and a Baha'i for 50.
Last edited by RonPrice : 01-07-2008 at 06:53 AM.
Reason: to add some words
2. My Experience of Manic-Depression:
Phase One--The First 37 Years 1943 To 1980
2.1 In the first 37 years of my life I had many episodes of various kinds of emotional imbalance or disorientation, themselves of varying lengths and intensities, ranging from a euphoric, impetuous, expansive or high mood to a depressed, grey, low energy or despondent mood. Indeed the range of mood in these 37 years was much more extreme, but the complete/extreme range was rarely experienced. In these years I learned various self-monitoring skills as well as some self-reinforcing tactics. Sometimes these symptoms affected my day-to-day life severely and negatively, sometimes positively and sometimes the affect was non-existent, insignificant and hardly noticeable.
2.2 After many experiences on the fringe of a normality that was my usual modus operandi or modus vivendi, as it is said in Latin , on the fringe of what I saw as my general everyday experience of life, an experience that is sometimes called the quotidian by writers, poets and novelists, I was diagnosed as a MD in May 1980. I was treated by a psychiatrist in Launceston Tasmania while in hospital. I had often been on the fringe of this disorder, as I say above, a borderline zone, a limen as some historians call it, a border territory, a zone between normality and various behavioural extremes and eccentricities from my birth in 1944 to 1980. But in 1980 the symptoms were extreme and required hospitalization. The treatment regime in 1980 was lithium carbonate, an antimanic medication for the treatment and prophylaxis of BPD. Lithium was the first really successful mood stabilizer used by doctors to treat MD, an illness that in the 1990s began to be called BPD. This medication cushioned the effects of extreme depression and hypomania and prevented their effects from striking at my life. The perils of BPD lie in what I did in the midst of hypomanic episodes to deal with: decreased need for sleep, decreased self-control, increased sexual desires, irritability, rage, risk-taking behaviours and, in my 1968 and 1979-80 episodes, schizo-affective or psychotic states; and in the midst of depression periods with moroseness, extreme melancholia and suicidal wishes.
2.3 My history to that point, to 1980, had been far from smooth and linear as my remarks above indicate. Those thirty-six years had often been bisected, polarised and traumatised. As I indicated above I have written a more detailed account of these years elsewhere but this outline, this brief sketch here, of particular episodes and the periods between episodes will suffice. My experience of these highly diverse emotional and psychological swings of mood in everyday experience away form the norm, from my norm, is only part of my story. But it is a crucial part. Everyone has their story for everyone experiences all sorts of abnormal eccentricities and health problems in life, some people of course more than others and some more traumatic and intense than others.
2.4 My account of the years from 1943 to 1980 follows. I try, in writing about and in summarizing these first 37 years of my life, not to overstate my case, nor to understate it, but give an account of those first 37 years which I refer to here in this general statement as phase one of my bi-polar life. In some ways the inclusion of the names of those doctors who treated me over the years in this first phase and in later phases would personalise this account, but names are not that important and to include them here in this narrative causes confidentiality problems and raises privacy issues for some readers and for people in my own past who might not want to be mentioned. This question of confidentiality and privacy is especially true at some internet sites where posts are rejected if names are included in any posting at the site concerned---and so I leave names out. Those whose names I could mention would not be troubled by their inclusion here, not now, not in 2008 after an extensive destigmatization of the disorder in recent years and after so much of my experience and so many of the people concerned are now, what you might call, ancient history.
2.5 1 I certainly appreciate the medical and clinical work of: (a) several of the doctors I went to in my childhood, adolescence and adulthood, (b) the psychiatrists who have treated me since June of 1968, nearly four decades ago and (c) many family members, friends, colleagues and associations, some known well and others hardly at all, who have helped me ride the waves when the disorder raised its head yet again along the way, the road of life.
2.6 Comments on My Ante-Natal, Neo-Natal,
Childhood and Adolescence Life: 1943-1963
2.6.1 As I refer to above, I had some experience of what may well have been BPD in childhood as far back as infancy and at the toddler stage, all of the pre-school years, 0-5, of early childhood development. My mother nearly died in the first month after my birth, the implications of which it is not my intention to go into here. If there are any significant implications of this birth process and/or events in my ante-natal and neo- natal phases of my life, I do not examine here, however important they may be in the aetiology of this illness. Before the age of five there is evidence that my behaviour had some of the features of what is now called Attention-Deficit/Hyperactivity Disorder (ADHD), but it is difficult to disentangle those features from those of BPD. For the most part, though, I did not manifest BPD symptoms like: elated mood, grandiose behaviours, decreased need for sleep, racing thoughts or hyper-sexuality. Children are developmentally incapable of many manifestations of BPD described in adults; for example, children do not "max" out credit cards or have four marriages, pre-puberal and early adolescent age equivalents of adult mania behaviours. Still, as David Healy emphasizes in his book Mania: A Short History of BPD, some doctors are now associating BPD as beginning in utero.
Perhaps in a later edition of this essay I will attempt a more detailed outline of what I recall from these years of early childhood, but my recollections are minimal and it is difficult, if not impossible, to excavate my memories from those years at this late stage of my life. It is not my intention to comment further on these early years except for the occasional passing reference when it seems appropriate.
2.6.2 Through middle and late childhood, say, the age of 6 to 12(1950-1956) into the puberty cusp of 12/13 in 1956/7, I did exhibit personality features, behaviours or symptoms that had features of BPD, at least to a limited degree, or so it could be argued if not proved: (a) a lack of control of my emotions, impetuosity, lack of emotional restraint, hyper-sexuality and (b) a far too intense activity threshold what is now called hyperactivity, mild mania or hypomania. It should be emphasized in this context, though, that mania is now considered by many in popular culture as a pleasantly grandiose, somewhat overactive feeling and behaviour orientation, but is not considered as evidence of a disorder, of insanity or of a maniacal posture. I recall at the age of 12/13, at the onset of puberty, exhibiting inappropriate or precocious sexual behaviour, although the particular manifestations only involved one episode which constituted groping and an attempt to kiss a girl who did not want to be kissed.
Adolescent BPD or adolescence presented me with an accentuation of puberty and teen-turbulence caused by hormonal shifts. Society value shifts in the 1960s accentuated my tensions and behavioural problems more, or so it seems to me, as I look back from the perspective of half a century. My mother’s understanding, commitment, perseverance and patience even though she did not know that I even had BPD is now in my memory bank and in my greater appreciation for my mother than ever before.
2.6.3 Although symptoms of BPD that I exhibited in childhood and adolescence are largely not described here, I could go back to my birth and, indeed, to conception itself and my in utero life as I intimated above, for possible origins and manifestations of BPD. The relationship with my mother, my sexual proclivities, my OCD tendencies could all be described, could be gone into, in more detail. I have also written about this subject briefly in my memoirs. I do not attempt in this now quite lengthy account to describe this period of my life in more detail, nor do I discuss my death wish or my suicidal tendencies during the many years of BPD beginning in the last months of my adolescent years, in October of 1963, during which I experienced the death wish for the first time. Before the official diagnosis of manic- depression in 1980 the death wish was only associated with a few periods of intense D. I do not allude to this death wish except en passant and, then, only in the most cursory fashion.
2.6.4 I don’t think I will ever know enough about the early years in my life before the age of 18 anyway, to assess whether my short periods of behavioural disorientation were examples of: (a) a mild-mania, hypomania, (b) BPD, (c) an affective disorder of some kind like schizo-affective disorder or (d) even OCD. The very validity of the diagnosis of BPD in paediatrics and in adolescent studies is now in question becoming, some say, a simple catchall applied to explosive and aggressive children and other kinds of idiosyncratic behaviour. Others say that many behavioural abnormalities are finally being recognized as part of a single disorder.
2.6.5 Keeping sexual stimuli under control has always been a struggle for me to regulate so that thoughts of a sexual nature did not claim too great a share of my attention. With the years, the half century since 1960, the opportunities to go over the top and to let physical/sexual temptations assume too great an importance have increased. My mother took a liberal attitude to my sexual frustrations and this liberal attitude became part of my own attitude to the battles I had to face in this domain of life’s tests.
2.6.6 It was not until much later in life, though, that I began to see my aberrant childhood behaviours and my aberrations at puberty and then in adolescence as possibly having a link with my future mental illness. It was not until I was 19 in 1963 that any characteristics of BPD became quite clearly apparent, pathological and, in retrospect, could be called part of BPD and given that medical diagnosis. At the time, though, in 1963 no doctor would have given, or at least gave me, that diagnosis. Looking back to the age of 19 in October of 1963, I recall feeling a depression so deep it was like ‘a sickness unto death’ that I had never experienced. It was a sadness so pathological that it made me feel suicidal, like death not warmed over, as one could say colloquially. It does not surprise me that the third leading cause of death among people aged 15-24 is, in fact, BPD. I could very easily have been one of those dead souls especially back in the early 1960s when there was such little understanding of this illness.
2.6.7 One can read about this intensity of depression in many fields of literature and of mental health, although the work ‘depression’ does not seem to have entered the lexicon until about 1900. The desire to die at that time was overwhelming. But I did not talk about it to anyone except perhaps my mother, although I honestly can not now recall the extent of my openness with her. She knew I was depressed but neither she nor I really understood the dynamics or the intensity of the depression. I think it was assumed that I would grow out of it. And I did. By December 1963 the depression began to lift. I wrote my December exams at university and I continued with my first year studies in liberal arts.
-----------INSTALMENT #3 TO COME LATER--------
__________________
married for 42 years, a teacher for 35 and a Baha'i for 50.
Awesome post dude! I'll have to reread this. Isn't it awesome how the gift of what we call "bipolarity" forces one to reflect intensely and greatly organize his/her life?
That's what you did and you are doing awesome, so enough said.
Remember what I said in the other post though, but I'm totally with you, although I look at it first as a gift, with normal only meaning being emotionall stable, and not anything to do with society's norms of course. I will re read this though because I skimmed, it's all kinds of interesting to me.
I'm pleased to hear some folks here are benefiting from my story. I can post more of it at this site. Let me know if you want more.-Ron Price, Tasmania
__________________
married for 42 years, a teacher for 35 and a Baha'i for 50.
Often readers find my posts on this subject too long and I'm sure there are some readers here who will also find my posts too long. I advise such readers simply to not read my posts. But due to the encouragement of ninja 9 months ago, I will post instalment #3.-Ron in Tasmania
-------------------------------------------
2.7 Comments on My Ante-Natal, Neo-Natal,
Childhood and Adolescence Life: 1943-1963
2.7.1 As I refer to above, I had some experience of what may well have been BPD in childhood as far back as infancy and at the toddler stage, all of the pre-school years, 0-5, of early childhood development. My mother nearly died in the first month after my birth, the implications of which it is not my intention to go into here. If there are any significant implications of this birth process and/or events in my ante-natal and neo- natal phases of my life, I do not examine here, however important they may be in the aetiology of this illness. Before the age of five there is evidence that my behaviour had some of the features of what is now called: (a) Attention-Deficit/Hyperactivity Disorder (ADHD) or (b) Oppositional Defiant Disorder, but it is difficult to disentangle those features from those of BPD.
2.7.2 For the most part, though, I did not manifest BPD symptoms like: elated mood, grandiose behaviours, decreased need for sleep, racing thoughts or hyper-sexuality. Children are developmentally incapable of many manifestations of BPD described in adults; for example, children do not "max" out credit cards or have four marriages, pre-puberal and early adolescent age equivalents of adult mania behaviours. Still, as David Healy emphasizes in his book Mania: A Short History of BPD, some doctors are now associating BPD as beginning in utero. Scientists are also making progress in finding the biological markers for depression, anxiety, and obsessive-compulsive neurosis. Markers are essential to understanding the anatomical basis of mental disorders, diagnosing them objectively, and following their response to treatment, as well as perhaps preventing psychosis in those at high risk.
Perhaps in a later edition of this essay I will attempt a more detailed outline of what I recall from these years of early childhood, but my recollections are minimal and it is difficult, if not impossible, to excavate my memories from those years at this late stage of my life. It is not my intention to comment further on these early years except for the occasional passing reference when it seems appropriate.
2.7.3 I would like to make a few remarks here on the biological, physiological, bases of BPD drawing on recent studies. The language I am drawing on here is difficult and I advise readers to pass over this section if they find it too complex in terms of the medical terminology I am using. The neurobiological abnormalities associated with BPD, the abnormalities characterizing episodes of mood disturbance in BPD, help elucidate the aetiopathogenesis, that is, the cause and development of BPD. There are immunological, neuroendocrinological, molecular biological and neuroimaging abnormalities characteristic of BPD. I will summarize these abnormalities in the following section, 2.7.4.
2.7.4.1 Trait neurobiological abnormalities of BPD include heightened pro-inflammatory function and hypothalamic–pituitary–adrenal axis dysfunction. Dysfunction in the intracellular signal transduction pathway is indicated by elevated protein kinase A activity and altered intracellular calcium signalling. Consistent neuroimaging abnormalities include the presence of ventricular enlargement and white matter abnormalities in patients with BPD. This may represent intermediate phenotypes of BPD. In addition, spectroscopy studies indicate reduced prefrontal cerebral N-acetylaspartate and phosphomonoester concentrations.
2.7.4.2 Functional neuroimaging studies of euthymic patients implicate inherently impaired neural networks subserving emotional regulation, including anterior limbic, ventral and dorsal prefrontal regions. Despite heterogeneous samples and conflicting findings pervading the literature, there is accumulating evidence for the existence of neurobiological trait abnormalities in BPD at various scales of investigation. The aetio-pathogenesis of BPD will be better elucidated by future clinical research studies which will investigate larger and more homogenous samples. These studies will also employ a longitudinal design to dissect neurobiological abnormalities that are the underlying traits of BPD from those abnormalities related to episodes of mood exacerbation or pharmacological treatment.
2.7.5 Through middle and late childhood, say, the age of 6 to 12(1950-1956) into the puberty cusp of 12/13 in 1956/7, I did exhibit personality features, behaviours or symptoms that had features of BPD, at least to a limited degree, or so it could be argued if not proved: (a) a lack of control of my emotions, impetuosity, lack of emotional restraint, hyper-sexuality and (b) a far too intense activity threshold what is now called hyperactivity, mild mania or hypomania. It should be emphasized in this context, though, that mania is now considered by many in popular culture as a pleasantly grandiose, somewhat overactive feeling and behaviour orientation, but is not considered as evidence of a disorder or of a maniacal posture. I recall at the age of 12/13, at the onset of puberty, exhibiting inappropriate or precocious sexual behaviour, although the particular manifestations only involved one episode which constituted groping and an attempt to kiss a girl who did not want to be kissed. In addition, in my years of late childhood(8 to 12) I was involved in: (a) stealing items from shops and selling them; (b) one breaking and entering experience in which the charge was dropped and (c) excessive intensity expressed in sport and other activities.
Adolescent BPD and adolescence generally presented me with an accentuation of puberty and teen-turbulence caused by hormonal shifts. Society value shifts in the 1960s accentuated my tensions and behavioural problems even more, or so it seems to me, as I look back from the perspective of half a century. My mother’s understanding, commitment, perseverance and patience, even though she did not know that I even had BPD, is now in my memory bank and in the greater appreciation for my mother than ever before.
2.7.6 Although the symptoms of BPD that I exhibited in childhood and adolescence are largely not described here, I could go back to my birth and, indeed, to conception itself and my in utero, ante-natal, life as I intimated above, for possible origins and manifestations of BPD. The relationship with my mother, my sexual proclivities, my OCD tendencies could all be described, could be gone into, in more detail and I do mention my OCD tendencies again in this statement. I have also written about this subject briefly in my memoirs. I do not attempt in this now quite lengthy account to describe this period of my life in more detail, nor do I discuss my death wish or my suicidal tendencies during the many years of BPD beginning in the last months of my adolescent years, in October of 1963, during which I experienced the death wish for the first time due to the intensity of my first depression. Before the official diagnosis of manic-depression in 1980 my death wish was only associated with a few periods of intense D. I do not allude to this death wish except en passant and, then, only in the most cursory fashion.
2.7.7 I don’t think I will ever know enough about the early years in my life before the age of 18 anyway, to assess whether my short periods of behavioural disorientation were examples of: (a) a mild-mania, hypomania, (b) BPD, (c) an affective disorder of some kind like schizo-affective disorder or (d) just a mild form of OCD. The very validity of the diagnosis of BPD in paediatrics and in adolescent studies is now in question becoming, some say, a simple catchall applied to explosive and aggressive children and other kinds of idiosyncratic behaviour. Others say that many behavioural abnormalities are finally being recognized as part of a single disorder or existing on a single continuum.
2.7.8 Keeping sexual stimuli under control has always been a struggle for me to regulate so that thoughts of a sexual nature did not claim too great a share of my attention. With the years, the more than half a century since 1956/7, the opportunities to go over the top and to let physical/sexual temptations assume too great an importance have increased. My mother took a liberal attitude to my sexual frustrations and this liberal attitude became part of my own attitude to the battles I had to face in this domain of life’s tests.
2.7.9 It was not until much later in life, though, that I began to see my aberrant childhood behaviours and my sexual and other aberrations (stealing, breaking and entering, excessive intensities) at puberty and then in adolescence as possibly having a link with my future mental illness. It was not until I was 19 in 1963 that any characteristics of BPD became quite clearly apparent, pathological and, in retrospect, could be called part of BPD and given that medical diagnosis. At the time, though, in 1963 no doctor would have given, or at least gave me, that diagnosis. Looking back to the age of 19 in October of 1963, I recall feeling a depression so deep it was like ‘a sickness unto death’ that I had never experienced. It was a sadness so pathological that it made me feel suicidal, like death not warmed over, as one could say colloquially. It does not surprise me that the third leading cause of death among people aged 15-24 is, in fact, BPD. I could very easily have been one of those dead souls especially back in the early 1960s when there was such little understanding of this illness.
2.7.10 One can read about this intensity of depression in many fields of literature and of mental health, although the word ‘depression’ does not seem to have entered the lexicon until about 1900. The desire to die at that time was overwhelming. But I did not talk about it to anyone except perhaps my mother, although I honestly can not now recall the extent of my openness with her. She knew I was depressed but neither she nor I really understood the dynamics or the intensity of the depression. I think it was assumed that I would grow out of it. And I did. By December 1963 the depression began to lift. I wrote my December exams at university and I continued with my first year studies in liberal arts.
------------INSTALMENT #4 TO COME IF DESIRED
__________________
married for 42 years, a teacher for 35 and a Baha'i for 50.
Last edited by RonPrice : 09-06-2009 at 07:45 AM.
Reason: to correct an error
Ron! It's fantastic to see you! Your diatribes are just fascinating!
Quote:
Originally Posted by RonPrice
Often readers find my posts on this subject too long and I'm sure there are some readers here who will also find my posts too long. I advise such readers simply to not read my posts. But due to the encouragement of ninja 9 months ago, I will post instalment #3.-Ron in Tasmania
-------------------------------------------
2.7 Comments on My Ante-Natal, Neo-Natal,
Childhood and Adolescence Life: 1943-1963
2.7.1 As I refer to above, I had some experience of what may well have been BPD in childhood as far back as infancy and at the toddler stage, all of the pre-school years, 0-5, of early childhood development. My mother nearly died in the first month after my birth, the implications of which it is not my intention to go into here. If there are any significant implications of this birth process and/or events in my ante-natal and neo- natal phases of my life, I do not examine here, however important they may be in the aetiology of this illness. Before the age of five there is evidence that my behaviour had some of the features of what is now called: (a) Attention-Deficit/Hyperactivity Disorder (ADHD) or (b) Oppositional Defiant Disorder, but it is difficult to disentangle those features from those of BPD.
2.7.2 For the most part, though, I did not manifest BPD symptoms like: elated mood, grandiose behaviours, decreased need for sleep, racing thoughts or hyper-sexuality. Children are developmentally incapable of many manifestations of BPD described in adults; for example, children do not "max" out credit cards or have four marriages, pre-puberal and early adolescent age equivalents of adult mania behaviours. Still, as David Healy emphasizes in his book Mania: A Short History of BPD, some doctors are now associating BPD as beginning in utero. Scientists are also making progress in finding the biological markers for depression, anxiety, and obsessive-compulsive neurosis. Markers are essential to understanding the anatomical basis of mental disorders, diagnosing them objectively, and following their response to treatment, as well as perhaps preventing psychosis in those at high risk.
I'm so glad that people are catching this earlier! It may make for more abortions though...
Quote:
Perhaps in a later edition of this essay I will attempt a more detailed outline of what I recall from these years of early childhood, but my recollections are minimal and it is difficult, if not impossible, to excavate my memories from those years at this late stage of my life. It is not my intention to comment further on these early years except for the occasional passing reference when it seems appropriate.
Totally feel you there, Ron. I had to write an autobiography in eighth grade and I couldn't remember much from preschool except about breaking my toy fire truck and a gas leak.
Quote:
2.7.3 I would like to make a few remarks here on the biological, physiological, bases of BPD drawing on recent studies. The language I am drawing on here is difficult and I advise readers to pass over this section if they find it too complex in terms of the medical terminology I am using. The neurobiological abnormalities associated with BPD, the abnormalities characterizing episodes of mood disturbance in BPD, help elucidate the aetiopathogenesis, that is, the cause and development of BPD. There are immunological, neuroendocrinological, molecular biological and neuroimaging abnormalities characteristic of BPD. I will summarize these abnormalities in the following section, 2.7.4.
2.7.4.1 Trait neurobiological abnormalities of BPD include heightened pro-inflammatory function and hypothalamic–pituitary–adrenal axis dysfunction. Dysfunction in the intracellular signal transduction pathway is indicated by elevated protein kinase A activity and altered intracellular calcium signalling. Consistent neuroimaging abnormalities include the presence of ventricular enlargement and white matter abnormalities in patients with BPD. This may represent intermediate phenotypes of BPD. In addition, spectroscopy studies indicate reduced prefrontal cerebral N-acetylaspartate and phosphomonoester concentrations.
Oh man, elevated protein kinase A is baaaaad news.
Quote:
2.7.4.2 Functional neuroimaging studies of euthymic patients implicate inherently impaired neural networks subserving emotional regulation, including anterior limbic, ventral and dorsal prefrontal regions. Despite heterogeneous samples and conflicting findings pervading the literature, there is accumulating evidence for the existence of neurobiological trait abnormalities in BPD at various scales of investigation. The aetio-pathogenesis of BPD will be better elucidated by future clinical research studies which will investigate larger and more homogenous samples. These studies will also employ a longitudinal design to dissect neurobiological abnormalities that are the underlying traits of BPD from those abnormalities related to episodes of mood exacerbation or pharmacological treatment.
2.7.5 Through middle and late childhood, say, the age of 6 to 12(1950-1956) into the puberty cusp of 12/13 in 1956/7, I did exhibit personality features, behaviours or symptoms that had features of BPD, at least to a limited degree, or so it could be argued if not proved: (a) a lack of control of my emotions, impetuosity, lack of emotional restraint, hyper-sexuality and (b) a far too intense activity threshold what is now called hyperactivity, mild mania or hypomania. It should be emphasized in this context, though, that mania is now considered by many in popular culture as a pleasantly grandiose, somewhat overactive feeling and behaviour orientation, but is not considered as evidence of a disorder or of a maniacal posture. I recall at the age of 12/13, at the onset of puberty, exhibiting inappropriate or precocious sexual behaviour, although the particular manifestations only involved one episode which constituted groping and an attempt to kiss a girl who did not want to be kissed. In addition, in my years of late childhood(8 to 12) I was involved in: (a) stealing items from shops and selling them; (b) one breaking and entering experience in which the charge was dropped and (c) excessive intensity expressed in sport and other activities.
It's a good thing you were a minor, Ron, otherwise that could be rape!
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Adolescent BPD and adolescence generally presented me with an accentuation of puberty and teen-turbulence caused by hormonal shifts. Society value shifts in the 1960s accentuated my tensions and behavioural problems even more, or so it seems to me, as I look back from the perspective of half a century. My mother’s understanding, commitment, perseverance and patience, even though she did not know that I even had BPD, is now in my memory bank and in the greater appreciation for my mother than ever before.
2.7.6 Although the symptoms of BPD that I exhibited in childhood and adolescence are largely not described here, I could go back to my birth and, indeed, to conception itself and my in utero, ante-natal, life as I intimated above, for possible origins and manifestations of BPD. The relationship with my mother, my sexual proclivities, my OCD tendencies could all be described, could be gone into, in more detail and I do mention my OCD tendencies again in this statement. I have also written about this subject briefly in my memoirs. I do not attempt in this now quite lengthy account to describe this period of my life in more detail, nor do I discuss my death wish or my suicidal tendencies during the many years of BPD beginning in the last months of my adolescent years, in October of 1963, during which I experienced the death wish for the first time due to the intensity of my first depression. Before the official diagnosis of manic-depression in 1980 my death wish was only associated with a few periods of intense D. I do not allude to this death wish except en passant and, then, only in the most cursory fashion.
Oh man, death wishes are not good. Thankfully you didn't have a genie nearby.
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2.7.7 I don’t think I will ever know enough about the early years in my life before the age of 18 anyway, to assess whether my short periods of behavioural disorientation were examples of: (a) a mild-mania, hypomania, (b) BPD, (c) an affective disorder of some kind like schizo-affective disorder or (d) just a mild form of OCD. The very validity of the diagnosis of BPD in paediatrics and in adolescent studies is now in question becoming, some say, a simple catchall applied to explosive and aggressive children and other kinds of idiosyncratic behaviour. Others say that many behavioural abnormalities are finally being recognized as part of a single disorder or existing on a single continuum.
2.7.8 Keeping sexual stimuli under control has always been a struggle for me to regulate so that thoughts of a sexual nature did not claim too great a share of my attention. With the years, the more than half a century since 1956/7, the opportunities to go over the top and to let physical/sexual temptations assume too great an importance have increased. My mother took a liberal attitude to my sexual frustrations and this liberal attitude became part of my own attitude to the battles I had to face in this domain of life’s tests.
2.7.9 It was not until much later in life, though, that I began to see my aberrant childhood behaviours and my sexual and other aberrations (stealing, breaking and entering, excessive intensities) at puberty and then in adolescence as possibly having a link with my future mental illness. It was not until I was 19 in 1963 that any characteristics of BPD became quite clearly apparent, pathological and, in retrospect, could be called part of BPD and given that medical diagnosis. At the time, though, in 1963 no doctor would have given, or at least gave me, that diagnosis. Looking back to the age of 19 in October of 1963, I recall feeling a depression so deep it was like ‘a sickness unto death’ that I had never experienced. It was a sadness so pathological that it made me feel suicidal, like death not warmed over, as one could say colloquially. It does not surprise me that the third leading cause of death among people aged 15-24 is, in fact, BPD. I could very easily have been one of those dead souls especially back in the early 1960s when there was such little understanding of this illness.
2.7.10 One can read about this intensity of depression in many fields of literature and of mental health, although the word ‘depression’ does not seem to have entered the lexicon until about 1900. The desire to die at that time was overwhelming. But I did not talk about it to anyone except perhaps my mother, although I honestly can not now recall the extent of my openness with her. She knew I was depressed but neither she nor I really understood the dynamics or the intensity of the depression. I think it was assumed that I would grow out of it. And I did. By December 1963 the depression began to lift. I wrote my December exams at university and I continued with my first year studies in liberal arts.
------------INSTALMENT #4 TO COME IF DESIRED
Bring on installment four, Ron! These are mind-boggling!
__________________
Quoth David Banner: "Like a pimp"
It's not a beer belly. It's a gas tank for a sex machine.
Tongue In Cheek Responses, But, they are still reponses. Often, when I "come out" and talk about my bipolar disorder and conversation does turn in the direction of humour because with mental illness in any form there is a humorous side. Not everyone sees the humour but that is true of all kinds of humour--some see it and some don't. Anway....here is the next instalment for whatever purpose readers on this thread may have.-Ron in Australia
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2.7.11 These behaviours, this depression, at the age of 19 or any of my behaviour before that last year of my teenage life(1963-1964), did not result in my receiving any medical attention. The first formal diagnosis of my illness was labelled a schizo-affective disorder(SAD) in 1968. SAD is a sort of hybrid condition between bipolar disorder and schizophrenia, although this distinction may be somewhat artificial. It may be inappropriate to have a discrete cut between the two disorders when both may represent part of a spectrum and symptoms of both disorders were part of my experience during the last half of 1968. This situation involved the possibility of a serious risk of harm to myself or others and required in July 1968 what is termed involuntary commitment to hospital. This case involved a severe BPD episode with dangerous-violent and aggressive behaviour as well as depressive episodes in August with suicidal ideation.
In retrospect, I now see the autumn of 1968 as the first formal diagnosis of my BPD, although I was not to personally receive/read that diagnosis until 1970 when I visited a psychiatrist in Kingston Ontario. At the age of 19, though, I was given lots of advice from religious to common-sensical: diet, exercise, prayer, vitamins, interesting leisure distractions/interests like horse-riding, watching TV, music, et cetera. After several months to several years, 1963 to 1968, the emotional aberrations disappeared or could be said to be sub-threshold at least for a time. My episodes over those years and in the years December 1977 to June 1980 seemed to exhibit quite separate and distinct tendencies and patterns from those I had experiences in the 1960s.
2.7.12 Hypomania(H) was always characterized by elation and D was always characterized by varying degrees of very low moods. Such an observation seems now to be so obvious as hardly to require a mention, but at the core of my experience of this problem was either D or H and the impact of their various symptoms. The boundaries between normality and abnormality, health and pathology are also blurred and indistinct. In addition they shift from person to person, doctor to doctor and decade to decade making one’s understanding of the problem more complex, more difficult. Within those five years, 1963 to 1968 though, the permutations and combinations of emotional variation were enough to being tears to the eyes of a brass monkey, as my mother used to say. Looking back in retrospect at those last years of my formal education, I see it as a miracle that I ever got my BA degree and my teaching qualifications labouring under such emotional chaos from time to time and often, week after continuous week in a variegated pattern.
2.7.13 Although the pharmaceuticalization of the post WW2 modern world had began in earnest by the 1960s, it had not taken off that earnestly as applications to the behaviours and symptoms that I exhibited back then. The most successful treatment I received, though, was pharmaco-therapy and this continued to be the case for the next forty years.
2.7.14 Sometimes there was a return of incapacitating symptoms; sometimes I simply exhibited impetuosity or lack of emotional restraint; at other times my moods were expansive, quasi-manic. Perhaps, as some of the BPD literature suggests, I was affected sporadically by the extremes of a psychomotor retardation and agitation which is characteristic of this illness. Combinatory, lateral, uneven, unusually sensitized thinking, particular sensitivity to energy levels and a state of increased awareness were all part of my experience in these five years. It is difficult to describe these five years in retrospect given the bizarre and chaotic nature of the experience. Given, too, a general context of a degree of normality and the inevitable routine and quotidian nature of life that went on inspite of everything, inspite of the emotional problems makes the description of the details of these experiences, after forty years, difficult.
2.7.15 In the years 1969 to December 1977 the symptoms of my BPD were sub-threshold, non-existent or not as extreme. I coped and my behaviour did not require or even suggest medical intervention. In the 1977 to 1980 episode, the next major episode, H and its various symptoms like elation and good feelings, were rare and varying intensities of D were common. The episode lasted from December 1977 to June 1980, some two-and-one-half years. The first episode had lasted off-and-on from October 1963 to December 1968, a little more than five years. This second major episodic-period only lasted half the length of time that the first had lasted, but this was only due to the lithium treatment that put an end to my symptoms quick-smart. Without the lithium which I began to take in the first week of May 1980—who knows what the BPD symptoms would have been? The sixth leading cause of disability and lost years of healthy life for people aged 15-44 years in the developed world is BPD. I had lost only fifteen months of employment due to hospitalization(6/68-12/68 and 5/80-12/80), although much more time of varying degrees of decreased functioning. In addition, taking an early retirement at the age of 55 and going on a disability support pension at 57 until I was 65 could add another ten years onto this one year of unemployment due to BPD, if I wanted to make a fully comprehensive statement of the affects of BPD on the total years of my unemployment.
2.7.16 In early December 1968 I had left the mental hospital in Whitby Ontario on a mild sedative. I think it was called valergan; but I’m not sure; I have forgotten its name after nearly 40 years. In the nine years from 1968 to 1977 I tried: exercise, diet, giving up smoking, sex, radiesthetics and hair analysis, jogging and play therapy, among a range of treatments to prevent or alleviate any incipient symptoms reoccurring.
2.7.17 In the episodes from 1977 through 1980 the constellation of: fear, paranoia(P) and the extremes of D were often as low as I had experienced in the sixties, in those chaotic years of that episode from 1963 to 1968. I experienced in those years 1977-1980 a range of emotional swings, but they were largely, at least as I recall looking back a quarter century later, at the D and P end of things. A psychiatrist in Ballarat prescribed stelazine or trifluoperazine, an antipsychotic drug. It was at first administered in early 1978 and it seemed to make things worse. In December 1978 I moved to Launceston with my wife and three children and, after a series of two or three quite severe emotional swings at both the H and the D end from January to May 1979, a psychiatrist at the Launceston General Hospital prescribed lithium. After just two or three days my symptoms were relieved never to return in the same form.
2.7.18 I include the above observations and comments on this second major episode because they throw some light on the first episode and place my childhood and adolescent experience of BPD, if indeed I had that disorder at all in those years, in a helpful perspective at least for me, if not for others who read this statement. Depressive episodes for those with BPD tend to have a median length about 6 months with manic episodes usually beginning abruptly and lasting for between 2 weeks and four to five months. My episodes of depression and mania were certainly within this range.
It is helpful to me to express my disorder this way, that is in longitudinal, retrospective, terms as far back as my childhood and this I hope will be helpful to other BPD sufferers and some readers of this document for other reasons. My account here may appear somewhat complex and labyrinthine for general readers and I would advise such readers not to try and follow all the permutations and combinations of my description of this disorder. My description is quite difficult for some to follow and for me to outline in detail and to understand in general. As I go about relating this story, I go about trying to place this narrative into some coherent form. It has taken these seven editions over eight years to get some sense of coherence, some sense of continuity, into what some biographers and autobiographers sometimes call a ‘chaos narrative.’
2.8 From My First Episode of MD in 1963
To My First Institutionalized Care in 1968:
2.8.1 The episode in 1963 continued in a complex series of forms up to and including 1968, as I have outlined above. This episode was not diagnosed as either MD or BPD in those years. This episode, part of my first phase of BPD as I see it in retrospect, did not receive any professional psychiatric diagnosis until June of 1968. From June 1968 to November of that year I received institutional care in: the Frobisher Bay, now Iqaluit, General Hospital; the Verdun Psychiatric Hospital in Montreal; the Scarborough General Hospital in a Toronto suburb and the Whitby Psychiatric Hospital about a 30 minute drive from Toronto. The story of those years from 1963 to 1968 and those four psychiatric units and hospitals were my years of university study and the first year of full employment. The story of these years is long, stony and tortuous and I will not write the account of these five years in any more detail since no medical diagnosis was given to me in writing or verbally. I did receive a great deal of advice and types of treatment: (a) more exercise and prayer, (b) a better diet and sex, (c) drug therapy, 8 ECTs and other types of therapy from talk to art and manual activities. I do write of these six months in these several facilities in my memoirs in much more detail than I do here. To write of it here would result in prolixity.
2.8.2 In June or July of 1968, though, one member of a battery of doctors, psychologists, psychiatrists and other care givers who were then providing my treatment program in Montreal Canada at the Verdun Psychiatric Hospital took a personal interest in my case. He was the first attending psychiatrist in my life about whom I remember anything at all. He was a Baha’i, a religion that had its origins in Iran in 1844; he was one of perhaps 4000 Baha’is in Canada at the time and perhaps its only psychiatrist. He was himself at the outset of his own career in psychiatry. I had been serendipitously institutionalized here after the onset in late May of 1968 of an episode of BPD which was given no name at the time, although colloquially I recall it being said I had become “bushed” or, as they say in Australia, “gone tropo.”
2.8.3 I had been working with the Inuit at the time in Canada’s high Arctic as a grade three classroom teacher. Looking back it seems highly fortuitous that this first institutionalized care that I received was, in part, from a psychiatrist who shared the same belief system as I did, the Baha’i Faith. I remember him taking me out into the community to meet some of the Montreal Baha’is and their friends. Such an exercise, I assume, he felt was a normalizing experience.
-------NEXT INSTALMENT TO COME WHEN AND IF DESIRED------
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married for 42 years, a teacher for 35 and a Baha'i for 50.
Last edited by RonPrice : 09-19-2009 at 05:25 AM.
Reason: to correct a spelling mistake
Don't know much about BPD. ninja's reply to your thread and his humorous replies actually made me read the installment. Until then, I didn't realize this was a personal experience thread that is layman-friendly.
Please continue.
__________________ Just because your mother thinks you're special doesn't mean I do
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