The Mania of Bipolar Disorder

Excerpt from WHERE ARE THE COCOA PUFFS? 

Chapter 9 

But before the argument made a dangerous turn,  they walked into the tavern. The locals took their eyes off their beers and took the four of them in, shifting a bit on their bar stools, feeling the power of Amanda as she laughed and flipped her purse about in the air.

Amanda could feel the power she had and knew that she commanded the room. Any of these deer-shooting, beer-drinking, snowmobiling good ol’ boys would give anything to be with her. Hell, if it weren’t for Ryan, she might have slept with them all. But he was there and had a power almost as great as her own; between the two of them the world was theirs to do whatever the fuck they liked. Nothing, nothing could stop them. All the things that she was going to do, now, starting tonight, she would begin — that novel that had been flying around her brain, well, she needed to get some money to start that, but once she finished that new dance that everyone loved to see her dance then everything would fall into place, and things wouldn’t be so confusing once she had the money — wait, what the hell was that hanging from the wall? Why was someone talking to her and distracting her from what was critical, which was something anyone who wasn’t dumb as shit could see? Of course she wanted something to drink! Wasn’t that why they were here? Were these people just stupid? What she really needed was a pen or a pencil and napkins, lots of napkins … anything! Order her anything! That thing staring at her from the wall was freaking her out; its eyeballs were watching her. Fuck! Things were flying at her now, those eyeballs sending things her way; some of this just needed to be put down …. Finally someone was handing her a pen and she began to write, already feeling better, each word adding power to the previous words — if she could write a thousand words, then that thing would stop staring at her.

Ryan sipped his beer and watched Mandy write. When she was done with one napkin she would stuff it in her purse and start on a new one. The tip of her tongue was slipping between her lips in concentration. When the waitress brought their food, she was irritated by the disruption, but ate and wrote, and did not enter into the conversation the rest of them were having. When the napkins were gone, Ryan got her more before she became distressed. What he really wanted to do was read what she was writing, to try to understand what was going on in her head. When she got up, taking her purse and heading for the bathroom, David asked, “Is she okay?”

“Yeah, she’s cool,” was his answer. When she came back from the bathroom, smelling of weed, he could tell that she was already calmer, and he didn’t question her desire to switch seats with him. He glanced at the large moose head in front of him and swore the thing was staring at him.

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NAMI ADVOCATE REVIEW

Love, Loss and Schizophrenia

By Taylor Poor, NAMI Education Program Coordinator

In Reis’s Pieces, Karen Winters Schwartz brings the devastation of schizophrenia—a journey difficult to comprehend even for those who have experienced it themselves—into the familiar setting of a lighthearted romance.

Reis Welling seems to have it all: early tenure at Cornell, a loving girlfriend and a research project that involves hiking some of the world’s most beautiful mountains. When his father dies of a heart attack, Reis starts to lose touch with reality, believing his department heads are spying on him and that even his girlfriend Ellen is involved with the conspiracy. His friends beg him to seek help, but he has to hit rock bottom—losing Ellen, his professorship and contact with his concerned family—before he finds the right treatment and the right doctor and starts gathering the pieces of his life together at last. When an attractive young woman interrupts his vastly different but relatively stable new life, Reis may even have another chance at love—that is, if he can find the courage to tell Kelly the truth about his stigmatizing illness.

Schwartz’s characters voices, as they describe Reis’s battle with mental illness, will echo with NAMI members and supporters who have said these lines themselves. Reis’s mother has the well-rehearsed response she always gives to well-meaning friends who ask whether schizophrenia is “some kind of multiple personality:” it’s a brain disease, a thought disorder, usually involving hallucinations and often much more. Reis’s psychiatrist, Dr. Benson, is the kind, intelligent, respectful clinician we all wish our family members could meet, telling Reis, “You’re right. I don’t know what it’s like, and I can’t tell you everything will be fine.” But, “You must first accept your illness for what it is: An illness. A brain disease.”

Schwartz’s prose is most powerful and authentic when describing the symptoms associated with Reis’s collapse into psychosis, and the heartbreaking emotional reactions of Reis’s family, friends and colleagues. Reis’s gradually jumbling speech patterns and increasing grandiosity ring true. Sure, in bringing the messy, complex landscape of mental illness into the context of a frothy novel, Schwartz has made some simplifications. Her descriptions are cliché—the first time Reis meets Ellen, she is depicted as having a “pleasing exterior” at odds with her aggressive athleticism. At the end of the book, I’m left wondering how the story would have read for a protagonist living with mental illness without Reis’s good looks and unassuming charm—he’s described multiple times as “gorgeous” or “very attractive.”

Yet Schwartz’s most significant triumph in writing this book is a major one toward the effort to de-stigmatize mental illness. She has placed schizophrenia in a context from which it is typically been excluded: everyday, “normal” life. For anyone who has faced the challenge of telling others about their own mental illness, or who has watched a family member deteriorate, this book will be a source of hope that the story of their struggle can find a wider audience.

SCRAMBLED EGGS...AND BRAIN-FRIED CHICKENS

SCRAMBLED EGGS…AND BRAIN-FRIED CHICKENS

by Karen Winters Schwartz

I’m sure I’m not the only one who immediately thinks about chickens and eggs almost every time they hear the word comorbidity. But the first time I found a hash pipe floating around with my daughters’ clothes in the washing machine, chickens and eggs were the furthest things from my mind.

I grew up in a family who appeared quite normal on the outside and the inside. In the early ‘60s, watching your mother dress up for cocktail parties while easing down the final few puffs of her unfiltered Pall Mall was the norm. My father sitting with his after-work gin and tonic while he caught up with the national news was the norm. I didn’t grow up exposed to blatant alcohol abuse or drug use of any kind. We were all June and ward Cleaver. Really, we were. Even as a teenager of the ‘70s, drugs barely phased my world.

Years later my husband and I continued the Cleaver tradition. Although I fell short of meeting him at the door in a pretty blue dress with my hair in a stylish flip, we raised our two girls in a very normal household. So when my two daughters suddenly turned from adorable little girls to unrecognizable teenage monsters with hash pipes and slips of paper decorated with curious, tiny, triangular squares in their pockets, we didn’t know how to respond, who to blame (other than ourselves), who to turn to for help, or how to stop the rollercoaster, eggshell crushing few years we were heading toward. Nothing in either of our lives prepared us for what was coming.when my older daughter’s behavior turned from that of a slightly difficult child to that of an unmanageable teenager, many hours of useless guilt bantering between me and my husband ensued: “What did we do wrong?” “Do you think it’s drugs?” “Why does she feel the need to do drugs?” “What could we have done differently?” “Am I a bad mom?” And on and on.

When she was ultimately diagnosed with bipolar disorder at the age of eighteen, we accepted this with a sigh of relief—at least this was something tangible, something “fixable.” By the time her younger sister started getting in trouble at school, doing drugs, acting oddly, becoming paranoid, and hearing voices, I could almost handle the double punch. By then I had educated myself, I had become involved in the National Alliance on Mental Health (NAMI, www.nami.org ), and I had become an advocate. But it was still hell—she was diagnosed with schizophrenia.

So where’s that chicken and where’s that egg?

Perhaps I should have been given a tiny ovum of foresight the first time our younger daughter woke us up in the middle of the night screaming in her little pink doll-baby pajamas with her moonlike eyes peering up at us without recognition and her face fixed in death-impending terror. But I was soothed by our doctor’s reassuring words: “Night terrors are very common. They are in no way related to future mental illness.” I now know that he was incorrect.

Perhaps my older daughter’s contention that she had ADHD in spite of her exemplary school performance should have sent up red flags. Maybe if I had known what I know now, I wouldn’t have placated her words: “You have no idea what goes on in my head!” But the fact is, other than a stubborn and sometimes difficult child at home, my older daughter was a perfectly charming, brilliant student who was well liked by her teachers and better liked by her friends.

Then there were the things I never knew about until later. Like the fact that my younger daughter used to sit in her second grade class and say, “Iron wall. Iron wall. Iron wall,” over and over to herself as she tried to limit the external stimuli flooding her young brain.

Then there was the time she was given steroids as a young child for a severe sinus infection and distinctly heard people talking to her. “Mom, someone just said cleanup in aisle seven in my head!” The moment the prednisone was decreased, the voices stopped.

So as these early prodromal symptoms grew, so did my children, and so did their access to things like weed and alcohol and random pills pilfered from grandmas’ medicine cabinets, thus providing them something like relief.

Yet my younger daughter did not become psychotic until after that bad LSD trip. My older daughter now admits that she was doing a lot of coke when she was most manic.

Egg. Chicken. Egg. Egg. 

I think what we have here is the first and second hit. The first hit being the genetic propensity for these illnesses along with an increased sensitivity to certain medications and drugs. The second is environmental. Stress, drug use, hormones, a viral infection, and head trauma have all been theorized. I have no doubt that my children were vulnerable. I know now that both sides of our families are peppered with mental illness. The use of drugs to quell prodromal symptoms could have easily brought the predisposed mental illness to the forefront. Drug use absolutely made things worse. we were lucky. Thanks to the help of a great practitioner and people I met through NAMI, my kids were helped quickly. Proper treatment was initiated and my children recovered before any sort of drug or alcohol addiction  took hold. Regardless of the accuracy of their initial diagnoses, the word comorbid was never part of the equation. Twenty to twenty-five percent of adults in the US will struggle with mental illness at some point in their lives. Over half of these individuals have a coexisting addiction. what can be done to decrease these percentages? How can we decrease that drug-induced second hit?

I believe early detection is the key—flagging those children who are genetically vulnerable, screening each and every child as we screen for other serious illnesses. we need to step in and treat those early prodromal symptoms before drugs and alcohol can take hold. This can be achieved by education, by open and frank discussions on mental health, by making it okay to talk, by decreasing the learned fear, and by promoting what is needed for recovery. Screening should be done on every child by pediatricians and family doctors. Mental health should be stressed and taught in our schools, starting at lower grade school levels. we should be talking to our children about our own struggles or those of other family members. I could never talk to my children because no one ever talked to me. I was forced to learn everything I now know about these neurological brain diseases out of desperation, out of despair, and out of necessity. what we went through as a family was unconscionable. we should have been educated and supported by our medical and human community rather than made to feel ashamed, judged, and helpless. Blame it on poor genes if you must, but these are no-fault neurological conditions that are not due to poor parenting or weak constitutions.

When it comes right down to it, eggs and chickens are not all that important. It really doesn’t matter if the egg predated the chicken or the chicken predated the egg, or even if they both occurred at the exact same time. what’s important is that we understand that both mental illness and addiction are often comingled. Both need to be acknowledged, understood, and treated. The cost of mental illness is huge; the cost of comorbidity is even larger—not only financially, but emotionally and physically. I believe the mental healthcare system is beginning to understand this. Now we just need to get the rest of the world to understand.

Karen Winters Schwartz, bestselling author of Where Are the Cocoa Puffs?: A Family’s Journey Through Bipolar Disorder (Goodman Beck Publishing, 2010) 
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Reis’s Pieces: Love, Loss, and Schizophrenia (Goodman Beck Publishing, 2012) 
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Reprinted from "The Sober World" * November 2012 * Volume 1, Issue 9