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My Chaos Narrative
My Chaos Narrative
My Chaos Narrative
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My Chaos Narrative
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My Chaos Narrative

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This is a 100,000 word, 200 page, longitudinal, retrospective and prospective account of my experience with bipolar disorder and some other mental health problems over 70 years: from October 1943 to …

This is a 100,000 word, 200 page, longitudinal, retrospective and prospective account of my experience with bipolar disorder and some other mental health problems over 70 years: from October 1943 to October 2013. This account is a personal, clinical, and idiosyncratic study of what some life-study students call a chaos narrative. This study focuses on an aspect of my life involving several mental health issues, but mainly bipolar 1 disorder. This account is now in its 13th edition. In my retirement, the years from 2001 to 2013, I have revised the account each year up-dating the content (i) as new information about the mental health issues I deal with are added to the science, and (ii) as I continue to deal with these mental health issues as I head to the age of 70 in 2014.

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  • 1. QUEUE UPLOAD ADMIN LOGOUT . . Home Search author Search title Journals Browse language New Popular Site map . . . >> Essays and poetry by Ron Price About this document (click for more) edit q·edit archived diff Abstract: This is a 95,000 word (160 page font-12 or 200 page font-14) longitudinal, retrospective and prospective account of my experience with bipolar disorder and some other mental health problems over 70 years: from October 1943 to October 2013. Notes: This is a personal, clinical, and idiosyncratic study of what some life-study students call a chaos narrative. This study focuses on an aspect of my life involving several mental health issues,mainly bipolar 1 disorder. This account is now in its 13th edition. In my retirement, the years from 2001 to 2013, I have revised the account each year. See also bahai- library.com/price_pioneering_four_epochs. Account of 69 Years of My Experience With Bipolar Disorder: A Personal-Clinical Study of A Chaos Narrative by Ron Price original written in English. FOREWORD This is a 95,000 word(160 page, font-12; 200 page, font-14) longitudinal, retrospective and prospective account of my experience with bipolar disorder, as well as several other mental health problems over 70 years: from October 1943 to October 2013. This is a personal, clinical, and idiosyncratic study of what some life-study students call a chaos narrative. This study focuses on an aspect of my life involving several mental health issues, but mainly bipolar 1 disorder. This account is now in the 1st draft of its 13th edition. In my retirement, beginning in the first year of the 3rd millennium, that is 2001, .
  • 2. I have revised the account each year to:(i) add the changes in my medications and life experience, and (ii) update the information base over the 70 years as information about BPD became available in cyberspace. This account aims to be as clinical as possible. It is not written as a narrative with episodes to keep readers wanting to read more, like a novel. It is not written to be an interesting, highly personal account, for publishers to market and achieve a big readership. It is, as I say above, clinical, medical, longitudinal and, for most readers, not a story to keep readers on the edge of their seats. It is written to be of help to those with an interest in this particular mental health problem, bi-polar disorder, and it is written to provide a life-narrative, one person's life experience of 70 years dealing with its manifestations in his life. PREAMBLE Part 1: The many manifestations of mental health problems like: neurotic and personality, psychotic and non-psychotic mental disorders are now one of the leading causes of death globally. The Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association provides a common language and standard criteria for the classification of mental disorders. The DSM is used in the United States and to various degrees around the world. It is used or relied upon by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies, and policy makers. The current version is the DSM-V-TR (fifth edition, text revision, comes out in May 2013). The current DSM-IV is organized into a five-part axial system. The first axis incorporates clinical disorders. The second axis covers personality disorders and intellectual disabilities. The remaining axes cover medical, psychosocial, environmental, and childhood factors functionally necessary to provide diagnostic criteria for health care assessments. My account is a far from systematic one dealing with each of this five-part axial system in turn. Being systematic in my approach was part of my problem when I began this account more than a dozen years ago. My story has become more systematic, but it has also become more idiosyncratic and personal. This 'chaos-narrative,' as some biographers and autobiographers call this genre of story-telling, has been strong longitudinal beginning as it does at my conception in mid-October 1943, and ending with the present, the months of 2013. Part 2: Mental disorders now account for a significant percentage of the non-fatal burden of disease. There is an estimated and staggering indirect cost of perhaps $200 billion a year in the USA alone when one includes the impact of: (i) incarceration, (ii) homelessness, (iii) the high rate of medical complications, (iv) dependence on emergency room care, (v) lower educational attainment, (vi) the reduced ability to hold jobs, and (vii) the burden on friends and families, inter alia. The above 7 factors and their application in the nearly 250 countries, as well as dependent and independent territories on the planet, could alone make for a separate
  • 3. book on the subject. Indeed, there is already an extensive literature on these many factors and in many of those 200+ countries for those who are interested. Those who want to follow-up in these relevant areas of interest on the subject now have a burgeoning literature available.(note:U.N. Members: 193, U.N. Observer States: 2, States With Partial Recognition: 2, Inhabited Dependent Territories: 45, Uninhabited, Territories: 6, Antarctica: 1, Total: 249) A recent US Surgeon General's report on mental illness concluded that at least 30% of Americans currently suffer from some form of mental disorder, including disorders in any of the following general categories: anxiety (most common), mood, eating, sexual, substance use, sleep, cognitive, psychotic, and schizophrenic, inter alia. This figure is comparable in Canada and many countries around the world. The three most common specific disorders appear to be: clinical depression, substance abuse, and social phobia or social anxiety disorder. For an extensive list of famous people with various mental illnesses and autobiographies go to: http://www.eddyelmer.com/pagestart.html?http://www.eddyelmer.com/celebrities- mental-illness.htm Part 3: All of the above, though, is not the focus of this story, this account which has now been at Bahá'í Library Online for several years, as well as at several other sites in cyberpsace. This account has now had at least 20,000 hits and, arguably, as many as 40,000. It is impossible to know how much of it has been read and by how many, even if the number of clicks or hits can be quantified. Readers will find below my personal account and experience of bipolar 1 disorder(BPD). It is my life-narrative and my experience with a special focus on the idiosyncratic manifestations of BPD in my life. For this reason, among others, I have posted part or all of what I call my 'chaos-narrative', as I say, at a number of internet sites. Mine, of course, is not the only story. There are now 100s, if not 1000s, of accounts of BPD in cyberspace. Mine is one of the most detailed due to its being the story, the experience of one person over his total lifespan of some seven decades. Some refer to such an account as 'coming-out-of-the-closet'. This experience has parallels to and with the experience of: lesbians, gays, bisexuals, transgender, pedophiles, people with criminal records and a host of others who keep some stigmatized social problem which is part of their lives---hidden as far as possible from others. Again, the literature on these several human predicaments is massive. Part 4: Severe mental tests are everywhere apparent, not only in the field of psychiatry and clinical psychology, disciplines whose role is to deal with these afflictions, but also across the wider culture in which we all live. These tests have been afflicting people across most cultures in the long history of humankind, but especially in the last century as the world‘s population has gone from 1.5 billion in 1914 to 7.5 billion in 2014. The onset of the Great War, 1914-1918, in some ways marked a new stage in the burgeoning problem of mental health and the tempests of our modern world. The new field of disaster psychiatry now plays a vital role in the evolving structures for
  • 4. preparedness and response in the fields of disaster management. Science and experience now address the tragedies of mass catastrophe with new systems. The challenges are massive for integrating mental health contributions into the practical requirements for survival, aid, emergency management and---ultimately and hopefully---recovery. The human face of disaster and the understanding of human strengths and resilience alongside the protection of, and care for, those suffering profound trauma and grief are central issues in relation to disaster psychiatry. These tests, disasters and crises will continue in the decades ahead as the tempest afflicting society continues seemingly unabated. There are now available, though, a burgeoning range of resources in today‘s print and electronic media to help people understand this complex and extensive field of mental health. My life-narrative, which I hope will be of help with respect to BPD, is but one small resource for readers. I have posted sections of this account at internet sites which contain a dialogue between people interested in particular mental health issues about which I have had some experience. Part 5: There are many internet sites today, some organized for and by mental health experts and others organized by non-experts for the general public and especially for sufferers of mental-illness to provide information as well as opportunities to discuss issues. In the process sufferers can, if they want, obtain help for what has become a very large range of specific disorders. If one goes to their google search engine and inserts the following words: mental health, depression, bipolar disorder, affective disorders, OCD, PTSD, anger management, indeed, any one of dozens of other disorders in this field, one discovers a host of sites of interest and of relevance to one‘s special concerns. According to one source, one-third of all people in western cultures will suffer from a disorder or emotional problem during their lifetime and they would benefit from therapy. In the last half century there has been a revolution in treatment programs and regimes which have found better and permanent cures for many, if not most, of the mentally afflicted, but there are millions more suffering from mental illness as well. In this world mental illness is truly a heavy burden to bear. I leave it to readers to do more googling for there is much to read for those who are interested in this subject. Despite the plethora of treatment options for BPD, this particular mental health problem remains suboptimal from the points of view of clinicians and patients alike in relation to many sufferers. Whether measured by recovery time from manic or depressive episodes or preventive efficacy of maintenance treatments, BPD is characterized by sluggish responses, inadequate responses, poor compliance and recurrences in controlled clinical trials. Results of naturalistic studies additionally show pervasive, often chronic symptoms, multiple episode recurrences, very infrequent euthymic periods when measured over years and marked functional disability in many patients.(Euthymic means a normal, non-depressed, reasonably positive mood distinguished from euphoria) Despite the explosion of treatment options over the last quarter century(1987-2012) when lithium dominated treatment, treatment resistance, that is the resistance, the failure of compliance, of those who have BPD, remains a central problem in BPD. If measured by symptom or syndrome recurrence status or functional status, the majority of treated BPD patients have a less than satisfactory outcome. My life experience with BPD is a
  • 5. good example of this reality, although at the age of 69 I have come to see my present treatment regime as "as good as it gets" in spite of at least 4 changes in my medication regime in the last 5 years. Part 6: I have joined over 100 of the internet sites in relation to mental health issues and participate, as circumstances permit, in the discussions on: mental health, bipolar disorder, depression and personality disorders among other topics in the field of psychiatry. What I have posted below is, as I say, also posted in whole or in part at many of these sites. I have posted this account here and at other locations in cyberspace because: (a)it is part of my own effort to de-stigmatize the field of mental illness and (b) it provides a useful longitudinal account of BPD for those who are interested. Many, if not most, BPD sufferers never go public about their problems due to the social stigma and my going public at this site among other sites is, as I say, part of my personal effort to destigmatize a part of the mental health problem that millions of people face. My own somewhat lengthy account below will hopefully provide mental health sufferers, clients or consumers, as they are variously called these days, with: (i) a more adequate information base to make some comparisons and contrasts with their own situation, their own predicament, whatever it may be, (ii) some helpful general knowledge and understanding, (iii) some useful techniques in assisting them to cope with and sort out problems associated with their particular form of mental health problem or some other traumatized disorder that affects their body, their spirit, their soul and their everyday life and (iv) some detailed instructions on how to manage their lives more successfully despite the negative consequences of their BPD or whatever trauma or illness affects their lives. For many readers the following post will be simply too long for their reading tastes and interests. In that case just file this document for future use, skim and scan it as suits your taste, go to the sections relevant to your interest or delete it now from your reading agenda. Apologies, too, for the absence of an extensive body of footnotes which I was unable to transfer to this document at BLO as this account developed.(2) Part 7: Trading in rumors and misinformation sensationalizes real disorders and leads to stereotypes and bigotry. This is evident by any cursory analysis of media coverage of the entire field of mental health. The media fuel the stigma that mental health is dangerous or scandalous and this fuel prevents people from seeking the life-changing help they need. Because untreated psychiatric disorders are more likely to result in violence, it makes tragedies like the Newtown Connecticut experience in December 2012 more likely to happen again. Speculating about the things we don't know goes on and on; we need to start focusing on what we do know. Additionally, a psychopathic, sociopathic or homicidal tendency must be separated out from mental illness more generally. While the mentally ill can sometimes be aggressive, this is usually because of a wide range of factors that this story discusses in its 200 page(font-14) ramble.Traumatic experiences like the recent(12/'12) Newtown killings are complex events and it is not my intention in this account of by BPD experience to deal with them except in some tangential sense.
  • 6. The extreme sensory sensitivities of many of the mentally-ill is just one of many contributing factors to the endgame of violence. Often the aggression of those with mental health issues is typically harmful to themselves. In the very rare cases where their aggression is externally directed, it does not take the form of systematic, meticulously planned, intentional acts of violence against a community. The media has already come under much scrutiny for its reporting many stories connected with mental health. Television reporters were hotly criticized for interviewing eyewitnesses, many of whom were children at Sandy Hook Elementary School in Newtown right after the trauma of the killing of many teachers and children om that morning. Some media outlets have refused to cross certain lines in their coverage. The internet now has a substantial number of posts on this topic for interested readers. Part 7.1 For two alternatives to reading my somewhat clinical story go to (3) and (4) below. There are now online many life-narratives, narratives which make more interesting reading than my more clinical account. There is, too, an excellent bibliography of the accounts of people's experience with BPD and an analysis of its presence in society.(5) -----------------------------FOOTNOTES------------------------------------------------------------ --------------------- (1) There is now a list of neurotic and psychotic, personality and non-psychotic mental disorders on the internet. The internet has excellent overviews of each and all of these mental health disabilities. (2) I have had difficulties placing footnotes into this document and so readers will not find the full list of annotations that I originally placed here. I hope to remedy this problem in a future edition. (3) The definitive medical monograph, at least for me, on the subject of BPD is: (Manic- Depressive Illness, with Frederick K. Goodwin, 1990; second edition, 2007) and a personal memoir (An Unquiet Mind, 1995). (4) For a more readable narrative than my rather clinical autobiographical account---go to Charlotte Pierce-Baker's "This Fragile Life: A Mother's Story of a Bipolar Son." This could very well have been my mother's story except for several factors which I discuss in my 160 page and 95,000 word account below. Charlotte did everything right when raising her son, providing not only emotional support but the best education possible. At age twenty-five, he was pursuing a postgraduate degree and seemingly in control of his life. She never imagined her high- achieving son would wind up handcuffed, dirty, and in jail. This is a moving story of an African American family facing the challenge of bipolar disorder, This Fragile Life provides insight into mental disorders as well as family dynamics. Pierce-Baker traces the evolution of her son‘s illness and, in looking back, realizes she mistook warning signs for typical child and teen behavior. Hospitalizations, calls in the night, alcohol and drug relapses, pleas for money, and continuous disputes, her son‘s journey was long, arduous, and almost fatal. This Fragile Life weaves a fascinating story of mental illness, race, family, the drive of African Americans to succeed, and a mother‘s love for her son.
  • 7. (5) Two among the many books now available which readers who have the interest can google with a little digging are: The Natural Medicine Guide to Bipolar Disorder, Charlottesville, VA, Hampton Roads Press, 2003; and Emily Martin, Bipolar Expeditions: Mania and Depression in American Culture, Princeton UP, Princeton, NJ, 2007. BIPOLAR DISORDER: A 70 Year Chaos Narrative A Longitudinal Context: October 1943 To October 2013 13th Edition, Draft #1 By: Ron Price of George Town Tasmania Australia (160 Pages: Font 12—95,000 words); Font-14-200 pages Disclaimer: This on-line book is offered for informational purposes & as an aid to others. It is NOT a substitute for medical advice. I make every effort to offer only accurate information, but I cannot guarantee that the information I make available here is always correct or current. Below readers will find my personal, idiosyncratic, story. Consequently, no one should rely upon any information contained herein, nor make any decisions or take any action based on such information. Consult your doctor before starting any diet or exercise program, taking any medication or, indeed, taking any action at all as a result of reading this work. I am not responsible for any action taken by those who rely in one way or another on the information contained herein and for any damages incurred, whether directly or indirectly, as a result of my errors, omissions or discrepancies contained in this account. The following information is NOT intended to endorse drugs or recommend therapy. While this account might be helpful it is not, as I say, a substitute for the expertise, skill, knowledge and judgement of healthcare practitioners in patient care. 1. Preamble and Introduction: 1.1 This medium-sized book was once very small, indeed, not much more than a long essay of about 2000 words. It started out as that very short essay twelve years ago in 2001: (a) as a statement to obtain a disability pension in Australia and (b) as an appendix to my memoirs, a five volume 2600 page opus found in whole and in part at various places on the internet. Both this statement and that book of my memoirs could benefit from the assistance of one, Rob Cowley, affectionately known in publishing circles back in the seventies and early eighties as ―the Boston slasher.‖ His editing was regarded by some as constructive and deeply sensitive. If he could amputate several dozen pages, several thousand words, of this exploration of my life experience of bipolar disorder(BPD) with minimal agony to my emotional equipment I‘m sure readers would be the beneficiaries. But, alas, I think Bob is dead. I did find an editor, a proof-reader and friend who did not slash and burn but left my soul quite intact as he waded through my labyrinthine passages, smoothed them all out and
  • 8. excised undesirable elements. But this editor is in the late evening of his life and, after editing several hundred pages of my writing, he has tired of any continued exercise in my literary fields and so I am left on my own. I have begun to assume the role that both Cowley and my friend exercised, but it is a difficult and relentless role and I, therefore, only take it up sporadically given the quantity of my writing which does require editing. Without my editor friend, who is now nearly 80 and leads a quiet non-editing life, I advise readers not to hold their breath waiting for me to do what is a necessary edit in this now lengthy work. Each edition of this work has involved editing and, as is often the case with editing manuscripts, one can literally edit forever. 1.1.1 John Kenneth Galbraith, the famous economist and a fine writer, had some helpful comments for writers like myself. So, too, did Galbraith‘s first editor Henry Luce, the founder of Time Magazine. Both Luce and Galbraith were aces at helping a writer like me to avoid excess. Galbraith saw this capacity to be succinct as a basic part of all good writing. Galbraith also emphasized the music and the rhythm of the words as well as the need to go through many drafts. I've always admired Galbraith, a man who helped me understand some of the mystery that is economics. He passed away while I was writing this book. I‘ve followed his advice on the need to go through endless drafts. I‘ve lost count of the number of changes, of additions and of deletions to this text. I know I have not avoided excess or repetition among other writing weaknesses that readers will find in the following pages. In some ways I have found that the more drafts I do, the more I have had to say. Excess is one of the qualities of my life, it seems to me, as I muse over seven decades of living, if I may begin the confessional aspect of this work in a minor key. And so it is that I have Galbraith watching over my shoulder and his mentor, Henry Luce, as well. Galbraith spent his last years in a nursing home before he passed away in 2006 at the age of 98. Perhaps his spirit will live on in my writing as an expression of my appreciation for his work and for a man who lived and worked not far from where I grew up and studied in Ontario, in Canada. His spirit is needed here for there is much editing that is required in this far too-lengthy work; but I do not have the energy or enthusiasm or, perhaps, even the skill, to take on the task. Spontaneity did not begin to come into this piece of exposition until, perhaps, one of the drafts of its fifth edition back in 2005. Galbraith says that artificiality enters a text along with spontaneity because of the process of writing many drafts. I think he is right; part of this artificiality is the same as that artificiality which one senses in life itself: at least that I sense. Galbraith also observed with considerable accuracy, in discussing the role of a columnist, that a literary man or woman is obliged by the nature of their trade to find significance three times a week in events, often, of absolutely no consequence. I trust that the nature of my work here, as I say a part of my memoir, what I have come to call my chaos narrative, will not result in my being obliged to find significance where there is none. I‘m not optimistic though. Perhaps I should simply say ―no comment‖ and accept the reality of the presence of the inevitable gassy emissions that are part of the world of memoirs. 1.1.2 This is not your usual book about illness where someone gets sick, someone gets well, and the story serves as an inspiration. People feel a need to talk or write about their illnesses, and most of us read these accounts with close attention if we have an interest in a particular illness. Such books are written to inform and encourage others, to bear
  • 9. witness to our common fate, and to give advice about how to avert some illness. The more inspiring, cautionary, and tutelary the book, the more eagerly the book is read. The book may even make the best-seller lists. This is not such a book. If it has any function as inspiration, it is far too clinical to ever be popular. It does not reflect the spiritual, metaphysical or religious disquietude that affliction provokes, although some aspects of my subjective, my intuitive, and my religio-philosophical experience are part of my story. There‘s a roster of distinguished preceding examples of the more popular type from Helen Keller‘s The Story of My Life to the moving book The Diving Bell and the Butterfly by Jean-Dominique Bauby, victim of the ―locked-in syndrome‖ from a massive stroke at age forty-three, which left him imprisoned in his paralysed body but with his mind intact; from Montaigne‘s description of what it‘s like to pass a kidney stone, to Alphonse Daudet‘s In the Land of Pain, as he lay dying of syphilis, to Betty MacDonald on her tuberculosis in The Plague and I. There are books on just about any medical condition written from the point of view of the sufferer, the doctor, or a family member, valued testimonials to an apparently inevitable part of the human lot, often treated in painting too, though seldom in fiction, as far as I know, although I have yet to examine this field. 1.2 This is a longitudinal, retrospective account going back to my conception in the last half of October 1943. The story continues up to October 2013, with a few paragraphs in Appendix 10 to foreshadow my final years beyond October 2013, the final years of my life whatever number of years that may be, years that this story will deal with in the years ahead as I continue this online account. This statement, even at nearly 95,000 words and 160 pages, is still a work in progress, as they say these days, some 70 years. 1.2.1 Neurobiological, neuropsychiatric and affective disorders like BPD are found in diverse forms as well as in a broad range of age of onset and in a specificity of symptoms. Little is still known about its pathogenesis, that is, the origin and development of the disease. What follows is one person‘s story, one person‘s life experience of BPD, an illness that silently and not-so-silently shaped my life. It is a focussed account on a part of my personal life-narrative with the many manifestations, the symptomology, of BPD as I experienced it. BPD shaped, but did not define, all that has been my life. It was a medical affliction that made for a certain inconstancy in living, a certain impulsivity, tendency to take risks, a vulnerability to addictions, and much else. BPD is treatable but not curable. My story of that ‗much else‘ to which I refer is found here. My entire autobiography is not found here for there is more to my life than this disorder and my experience of its highs and lows, its joys and sorrows. 1.3 I make reference to a strong genetic contribution to the aetiology of BPD, a genetic predisposition, a genetic susceptibility as a factor in the pathogenesis of BPD. No specific gene has yet been definitively linked to BPD, although some chromosome regions have been implicated by several studies. Thus, despite extensive research efforts, the underlying patho-physiology of BPD remains unknown. I have been and still am part of an ongoing study into BPD conducted at the University of New South Wales and, I trust in due course, this illness like so many others will find better and better treatments, if not cures. 1.3.1 A family history, what is sometimes referred to as a family pedigree, of affective
  • 10. disorder in a first-degree relative, in my case my mother(1904-1978) is relevant to this narrative. My mother had a mild case of what may very well have been BPD, at least I have come to think of her mood swings as falling into a significantly high place in what is sometimes called the BPD or affective spectrum during her 75 year life. Her mood- swing disability or affective disorder, though, was never given the formal medical diagnosis manic-depressive(MD), a term which developed from several concepts as early as the 1850s if not centuries before. The term MD was replaced in 1980 after my mother died in 1978 by the term BPD. In retrospect my mother exhibited symptoms which may be more accurately labelled: (a) explosive disorder disability, (b) neurotic disorder: anxiety state or (d) depressive disorder. I know nothing of the mental health of my mother‘s parents or grandparents and so am unable to draw on what could be a useful knowledge base to explain the origins of my BPD. 1.3.2 Definition: Bipolar disorder (BPD) or manic-depressive disorder (also referred to as bipolar affective disorder or manic depression (MD)) is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood and one or more depressive episodes. The elevated moods are clinically referred to as mania or, if milder, hypomania. Individuals who experience manic episodes also commonly experience depressive episodes or symptoms, or mixed episodes in which features of both mania and depression are present at the same time. There is a defect in the transmission of sense impressions to the brain, a flaw in communication. (See: Monica Ramirez Basco, The Bipolar Workbook: Tools for Controlling Your Mood Swings, 2006. p. viii). These episodes are usually separated by periods of "normal" mood, but in some individuals, depression and mania may rapidly alternate, known as rapid cycling. Extreme manic episodes can sometimes lead to psychotic symptoms such as delusions and hallucinations. BPD has now been subdivided into: bipolar I, bipolar II, cyclothymia, and some other types based on the nature and severity of mood episodes experienced. The range of types and experiences is often described as the bipolar spectrum. –See Bipolar Disorder, Wikipedia, the free encyclopaedia. For an excellent overview of the subject of depression go to this link: http://www.nybooks.com/articles/archives/2007/dec/06/talking-back-to-prozac/?page=2 ...The internet is now overflowing with information and stories about depression. 1.3.3 Bipolar I disorder is the name given to the diagnosis when a person has hypomanic and, in most cases, depressive episodes. The several typicalities or the spectrum of episodes for BPD I include: (i) single manic or hypomanic episode, (ii) most recent episode hypomanic, (iii) most recent episode manic, (iv) most recent episode mixed, (v) most recent episode depressed, and (vi) most recent episode unspecified. To the extent that I am labelled BPD I, I would fit into sub-categories (ii), (iv) and (v). In April 2012 a new psychiatrist diagnosed me as BPD I. In the immediate future, the years from, say, 2013 to 2023, this new psychiatrist will be the major professional doctor on whom I will draw when necessary. 1.3.4 The diagnosis of Bipolar II disorder is reserved for those who have primarily one or more depressive episodes and one or more elevated moods. They have highs and lows but never have a hypomanic or manic episode. In BPD II, if the patient does have a hypomanic episode it does not necessarily cause the impairment of their working or family situation. It may even be associated with good functioning and enhanced
  • 11. productivity. Without proper treatment, though, hypomania can develop into mania in some people or can switch into depression. In my case, my elevated mood switched into depression in October 1963, August 1964, and some time in the early months of 1978. I was BPD II or mildly schizo-affective in my four years at university(1963-1967). My mood also switched from normal to manic in May 1968 and May 1980. These were the two times when I went through a full manic episode. 1.4 My father also suffered from what seems to me now, in retrospect, a mild case of what today is sometimes called intermittent explosive disorder(I.E.D.) or impulse control disorder(I.C.D.), as opposed to planned acts of violence or a simple temper. Given the rarity of I.C.D., it seems to me that my father had only a mild I.C.D. Other names for I.E.D. include: rage attacks, anger attacks and episodic dyscontrol. People with I.E.D. experience anger which is grossly disproportionate to the provocation or the precipitating psychosocial stresser. My father may have been exposed to this type of behaviour as a child and so his I.E.D. may have been learned rather than organic and brain-centerd. There are also complications associated with the diagnosis of I.E.D. and they include job or financial loss. My father lost much money on the stock market in his early 60s. My father was also genuinely upset, regretful, remorseful, bewildered or embarrassed by his impulsive and aggressive behavior. This description is an intuition since he and I never talked about his anger. In my father‘s late 60s, and perhaps at earlier stages in his life, his disorder also exhibited, or so it seems to me now in retrospect, co-morbidity perhaps due to his genuine sense of remorse, but I don‘t know for sure. I know nothing, either, of the mental health of his parents or grandparents all born in the 19th century. My conclusions regarding my father‘s emotional disability are largely, as I say, somewhat tentative. Perhaps he just had a bad temper as they used to say until the last three decades when psychiatry began to give his disorder a label. 1.4.1 About half of all patients with BPD have one parent who also has some form of mood disorder. There is then, or so it seems to me, a clinical significance in my mother‘s and father‘s mood disorders in the explanation of the origins and diagnosis of my own BPD. The high heritability of BPD has been well-documented through familial incidence, twin and adoption studies. There is an unquestionable justification for the inclusion of my family in the understanding of my BPD. No specific gene has yet been identified as the one bipolar gene. It appears likely that BPD is caused by the presence of multiple genes conferring susceptibility to BPD when combined with psychosocial stressors. 1.4.2 Advanced paternal age is a risk factor for BPD in the offspring. Since my father was 55 when I was born, the hypothesis that advancing paternal age ―increases the risk for de novo mutations in susceptibility genes for neurodevelopmental disorders‖ has some relevance to my having BPD.‖(Psychiatric News, November 7, 2008, V.43 No. 21, p. 18.) The offspring of men 55 years and older, that same article went on to say, were 1.37 times more likely to be diagnosed as having BPD than the offspring of men aged 20 to 24 years. The maternal age effect was less pronounced. For early-onset cases, that is BPD onset under the age of 20, and that was the case with me, the effect of paternal age was much stronger; whereas no statistically significant maternal age effect was found. 1.5 For an elaboration of the subject of the genetic connection of BPD and in utero BPD see: David Healy‘s Mania: A Short History of BPD Johns Hopkins, 2008. A short history of BPD is also available on the internet. Genes may also contribute to the age of
  • 12. onset of BPD and this is analysed now in the context of a phenomenon called genetic anticipation. Anticipation refers to the phenomenon of an illness occurring in successive generations at earlier ages of onset and/or increasing severity. In a recent study using registry data of BPD subjects, age at onset of the first illness episode was examined over two successive generations. Subjects born from 1900 through 1939(my mother) and from 1940 through 1959(myself) were studied. The median age at onset of the first episode of BPD was lower by 4.5 years in subjects born during or after 1940. It was not until my mother was in at least her twenties that her first episode of BPD occurred, although this is somewhat of a guesstimation. 1.5.1 BPD and affective disorders of various kinds run in the family. I am unable to trace my BPD back several generations. If I knew more about the many generations that preceded me in my birth family and their: episodes of hearing voices, delusions, hyper- religiosity, and periods of not being able to eat or sleep—that knowledge could prove useful and, possibly, predictive due to the genetic causal factors in relation to BPD. These episodes, these types of experiences, are often remarkably similar across generations and between individuals according to some studies within modern psychiatry and its pharmacological treatments. This is the story of my BPD and my treatments especially since September-October 1963. 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 also go back as far as Turkey in ancient history. 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 psycho-pharmacology, 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. There may be, in fact, pervasive developmental disorders that involve a triad of deficits in social skills, communication and language. For the underlying neurobiology of these symptoms, disturbances in neuronal development and synaptic plasticity have been discussed, but I don‘t want to comment on this area of complexity, this puzzling area and the aetiology of BPD.
  • 13. 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 neurobiological 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 2 diagnoses before 1978 and after 1962 from friends, family and concerned others. These two diagnoses were: depression and "a person with complicated troubles", to put it colloquially and in the daily vernacular. I received 2 diagnoses from psychiatrists during this time. The psychiatric diagnosis in 1968 was: a mild schizo- affective state; the diagnosis in 1978 when another episode of low mood, or depression, occurred. The psychiatrist I went to at the time, in Ballarat Australia, treated me with stelazine (trifluoperazine HCl). This was supposed to be effective as a short-term treatment of generalized non-psychotic anxiety. 1.9.1 The diagnosis that was made in 1980 was BPD. BPD is a diagnosis that is standardized according The Diagnostic and Statistical Manual of Mental Disorders (DSMMD-III: 1980, DSM-IV: 1994, DSM-V-5/2013) 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. 1.9.2 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, 2001 to 2011, 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. 1.9.3 In my case, my caregiver, namely my wife, evaluated me at 61-70 on the numeric scale in 2007 while I was on what I hoped was my last, my final, medication package. 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. Of course, many people do not deal with their BPD story and the relevant government departments honestly and they obtain government assistance when, in all honestly, they should not. Due to the complexity of BPD and its behavioural manifestations it is difficult for all concerned to monitor and report. Readers wanting access to this diagnostic tool can easily find it on the internet. I have appended it to this statement in
  • 14. appendix 2. 1.9.4 With the introduction of psychoactive drugs in the 1950s, and sharply accelerating in the 1980s, the focus in psychiatry shifted from talk therapies like Freudian psychology, to the brain. Psychiatrists began to refer to themselves as psycho- pharmacologists, and they had less and less interest in exploring the life stories of their patients. Their main concern was to eliminate or reduce symptoms by treating sufferers with drugs that would alter brain function. An early advocate of this biological model of mental illness, Leon Eisenberg, a professor at Johns Hopkins and then Harvard Medical School, in his later years became an outspoken critic of what he saw as the indiscriminate use of psychoactive drugs, driven largely by the machinations of the pharmaceutical industry. I mention this here because the subject of psychiatry and the various treatments for mental illness has become highly controversial and complex. The field has always been complex. For some of the claims and some of the defence from critics of medical and therapeutic advances in psychiatry go to this link:http://www.nybooks.com/articles/archives/2011/aug/18/illusions-psychiatry- exchange/ 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. 1.10.1 A good example of one of the most recent findings is from psychologists at the Universities of Manchester and Lancaster in a study published in April 2011. These psychologists say their findings are important because they mean talking therapies, like cognitive behavioural therapy (CBT), could prove effective treatments for BPD. Mood swings of people with BPD, these findings indicate, can be predicted by the current thoughts and behaviour of BPD sufferers. People with BPD are prone to extreme mood swings that take them from great emotional highs to the pits of depression; the cause of these mood swings is often put down to the patients' genes and biology rather than their own thoughts and actions. In a recent study published in the American Psychological Association journal Psychological Assessment, researchers followed 50 people with BPD for a month. The team found that the patients' thinking and behaviour predicted their future mood swings even when their medical history had been accounted for. "Individuals who believed extreme things about their moods; for example, that their moods were completely out of their own control or that they had to keep active all the time to prevent becoming a failure, developed more mood problems in a month's time," said study lead Dr Warren Mansell, in Manchester's School of Psychological Sciences. "In contrast, people with BPD who could let their moods pass as a normal reaction to stress or knew they could manage their mood, fared well a month later," said Mansell. These findings are encouraging for talking therapies such as CBT that aim to help patients to talk about their moods and change their thinking about them." A new form of CBT, known as TEAMS (Think Effectively About Mood Swings), is being developed by Dr Mansell and colleagues, at The University of Manchester. It aims
  • 15. to improve on previous therapies by focusing on current problems, like depression, anxiety and irritability, and helping patients to set goals for their life as a whole. The aim of this new approach is to encourage patients to accept and manage a range of normal emotions – like joy, anger and fear – and a controlled trial is about to start following a successful case series of the TEAMS approach. The researchers will use the TEAMS approach to follow up their current findings with a larger study that identifies who relapses and who heads towards recovery in the long term. In addition, MRP (The Mind Resonance Process) totally unrelated to CBT claims to permanently and completely delete the negative thoughts, emotions (and negative memories responsible for the former) and helps to restore resilience, self-esteem, self- confidence, and much more. Clients who have failed CBT, EFT, EMDR, psychotherapy, NLP, hypnosis, etc. often achieve significant and permanent life changing success with MRP empowerment coaching. We all have a life history "movie" which is always playing in the background and acting as a "set point" to which we always are drawn (down) back to. We all carry our history in this script or movie form and are simply not able to transcend it easily. Hence the need for all the talk and all the medications. 1.10.2 The original conceptualization of stress and the stress response has been developed based on the understanding that certain environmental exposures and life events can be both detrimental to individual's health and well-being, and also promote physiological responses that can be adaptive. I have little doubt, as I review those episodes of BPD in my life, that my exposure to environmental and life events at the time preceding those episodes were detrimental to my health. My vulnerability to stress, or the negative consequences of stress may have been due to a lack of resilience. Only recently has the field of psychiatry started focusing on the concept of resilience, exploring the possibility that, similarly to stress vulnerability, there could be unique mechanisms involved in resilience to stress. For more on this topic go to this link: http://www.nature.com/npp/journal/v37/n2/full/npp2011259a.html?WT.ec_id=NPP- 201201 1.11 BPD is not medically curable, as I point out elsewhere in this account, but it is possible through psychiatry, medicine, some types of talk therapy like the one indicated above, and nutritional supplements or adjuncts, to achieve varying degrees or periods of long-term stability. BPD needs to be managed like many other chronic diseases, with combination therapies and long-term treatment in order to achieve sustained success. I feel I have achieved this stability and this success 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(i.e. mild mania) 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 90,000 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 some research shows that some forms of psychotherapy or talk therapy are an effective substitute for or
  • 16. accompaniment with medication. Medication plus a structured psychotherapy has been compared to medication plus a less structured psychotherapy or medication alone. Building on earlier studies over the last 5 years, a variety of psychotherapy techniques have been evaluated, including family-focused treatment (FFT), cognitive therapy (CT), group psychoeducation, and interpersonal and social rhythm therapy (IPSRT). For all approaches, the addition of the structured psychotherapy added additional benefit, as measured by a variety of outcome variables, including longer survival time before relapse, fewer relapses, greater reductions in symptom rating scales, enhanced compliance, fewer days in mood episodes, improved social functioning, and fewer and shorter hospitalizations. At the age of 69 and generally happy with my medication regime, at least in many respects, I do not seriously entertain these psychotherapeutic approaches after more than 30 years of dependence(1980-2013) on mood stabilizers, anti-psychotic, and anti- depressant medications. I may seriously consider engaging in talk therapy in the years ahead; I may also entertain a change in my medications. Time will tell. I have taken medication in some form for more than 40 years, 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 of some value 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. Symptom reduction is one of the main aims of any talk therapy or psychotherapy in general, and can be regarded as the benchmark against which the success of behavioural and cognitive therapies is to be measured. Elucidation of the neural correlates of symptom reduction is a primary goal of any investigation into the biological mechanisms of psychotherapy. But, as I say, I don't go down this road and haven't since going onto lithium in 1980. 1.11.2 I could go to see a counsellor, general psychologist or a clinical psychologist for some talk therapy, perhaps CBT. My psychiatrist is a specialist in pharmacology and in treating BPD among other psychiatric illnesses. 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 pharmacology as a weapon in his arsenal. I have not seen my old, my previous, psychiatrist for nearly five years, since November 2008. In April 2012 I began seeing a new psychiatrist because I believed my needs to be chemical, pharmacological. I had been taking the same 2 meds for five years(2007-2012) and my wife wanted me to have a second psychiatric opinion. If I want to tweak my meds I can visit him or just work out a different package in consultation with my wife and/or my GP. I have discussed my memory and OCD issues with my psychiatrist several times, but both my psychiatrists have felt these were not serious enough problems with which I should be concerned. Often my regular doctor, my GP, nails my problems and takes away any need I have to see my psychiatrist. After four visits to my new, my latest psychiatrist in April-May 2012, I now work out any issues arising from my BPD with my wife. 1.11.2.1 Thanks to: (a) shock anti-schizo-affective treatment and supportive psychotherapy in the 1960s, and (b) ongoing medications--I have had quite a ―normal‖ life. In my case this normality is found in: (i) my capacity to devote my time and my
  • 17. professional life to intellectual and service occupations, basically teaching in the social sciences and humanities, and (ii) my maintaining an active intellectual life, with hope, strength, and making sense of reality. Another important point in this complex of normality has been my religious faith. Without these several factors, the pharmacological treatment alone would, quite likely, have failed. BPD1 is a horrible illness for most who have to deal with it, but nowadays I can say it is possible to have a ―friendly‖ relationship with this enemy of the mind. People with BPD have, in some ways, a fragile purchase on the world, and it is much more important that they have somebody—a professional in the public world and a friend in their private world—who can, over time, create that state of trust that is essential for ongoing daily life. This is true, of course, for all of us with or without mental illness, when the dark clouds of life roll in and overwhelm us. I have been fortunate to have such people as far back as the first episodes of BPD. 1.11.2.2 Though not as severe as full-blown Alzheimer‘s disease or other forms of dementia, mild cognitive impairment is often a portent of mind-robbing disorders like Alzheimer‘s. One study described seven stages of Alzheimer‘s disease. Mild cognitive impairment was seen as a mild Stage 3 of Alzheimer‘s. It is a condition of subtle deficits in cognitive function that nonetheless allow most people to live independently and participate in normal activities. Mild cognitive impairment could be described as an intermediate state of cognitive function, somewhere between the changes seen normally as people age and the severe deficits associated with dementia. At worst this is what I have, a mild cognitive impairment, but I am strongly disinclined to think so; at the age of 69 this is just a guess when I focus on the negative aspects of BPD. 1.12 Defining what psychiatry is & what mental illnesses are can often seem a circular process; it is also an increasingly complex process. Psychiatry, as it is currently constituted, is a branch of medicine. While contemporary psychiatrists tend to aspire to practice their training & the structure of the vast majority of psychiatric practice fits a medical model. People present with symptoms and exhibit signs which are examined. If these symptoms and signs are deemed to provide evidence of pathology, they lead to a diagnosis of an illness. Investigations and treatments are ordered. Medications and other interventions are prescribed to treat the illness. The cessation of the symptoms and signs marks recovery from the illness. This is, on the surface, similar to how an ophthalmologist would approach cataract, or a respiratory physician chronic obstructive pulmonary disease.Dictionary definitions of psychiatry describe it as the medical specialty concerned with mental illness (Oxford English Dictionary, 2007) Psychiatry textbooks generally gloss over the actual meaning of mental illness; they also assume it has a readily understood and commonly accepted meaning. 1.12.1 ―Diagnostic validity‖ means that a diagnosis is in fact a correct one. It differs from a related concept, reliability, which describes how well diagnoses match each other—a reliable diagnosis of BPD means that other clinicians would come up with a diagnosis of BPD given the same case. It is possible for a diagnostic process to be reliable but not valid, although validity implies reliability. Validity implies that one is describing an entity whose existence and nature is not disputed. It does not address fundamental questions of what this entity actually is. Psychiatrists spend much of their time trying to improve the image of psychiatry within medicine by insisting it is a scientific enterprise characterised by the assumptions of expertise, specialist knowledge
  • 18. and greater objectivity that it is assumed are possessed in full by other medical specialties. However psychiatry, as shall be seen, is also intimately concerned with values and the concerns of the humanities. The tension between the worldviews of ethical and political philosophy on the one hand and the traditional scientific view on the other is particularly acute in psychiatry. The concept of ―mental illness‖ can be considered an assumption in common usage within the psychiatric profession and, perhaps,in wider society. This concept has been subjected to a thoroughgoing critique from philosophers,psychiatrists, psychologists, social workers, political scientists, feminists and many other figures. 1.12.2 This critique has taken five main approaches: -a psychological model, as exemplified by the British • psychologist Hans Eysenck, arguing that mental disorders are in fact learned abnormalities of behaviour (Eysenck 1968) • a labelling model, as exemplified by the American sociologist Thomas Scheff, who argued that the features of mental disorder are in fact a response to the labeling of an individual as ―deviant‖ (Scheff 1974) • a ―hidden meaning‖ model, postulating that the apparently irrational, harmful or meaningless behaviour associated with mental disorder is in fact meaningful. The Scottish psychiatrist R.D. Laing, for instance, argued that ―madness‖ was a sane response to an insane society. (Laing, 1960) • an ―unconscious mind‖ model, influenced by psychoanalysis, which postulates that, again, the apparently irrational can be comprehended, this time with reference to the unconscious mind. • political control models—this critique of psychiatry sees it as a legitimising the social status quo and allowing those who dissent from it to be labelled mentally ill. The practice of psychiatry in the former Soviet Union exemplifies this. Another example is the feminist critiques of post-natal depression, which feminists would argue reflects society‘s treatment of mothers rather than being a disease per se. Thus legitimate distress at the unfair structure of society is pejoratively labelled an illness. Similarly, the Franco-Algerian psychiatrist Frantz Fanon argued that psychiatry was a tool of colonial control and part of the hegemonic order of industrial capitalism. 1.12.3 This questioning, much of which has been posed by psychiatrists, has forced psychiatry to scrutinise its own concept of what constitutes mental illness. Many of the critiques are more about the role of various psychological, social and political factors in the development of mental illness, rather than being an attack on the basic concept of mental illness. Other critiques have not so much been of psychiatry as a discipline or practice, but on the cultural significance of a therapeutic ethos, for instance that of Philip Rieff in ―The Triumph of the Therapeutic.‖ (1965) For Rieff, the rise of psychotherapy and the ―psychological man‖—marked a turning point in human culture, being the death- knell of a Western culture whose ideals had lost their power to deeply pervade the characters of its members. In a therapeutic ethos, truths are contingent and negotiable, and commitments or faiths only survive as therapeutic devices easily discarded in the
  • 19. interests of therapy. For Rieff, this is a symptom of Western cultural decadence and decline. 1.12.4 Much of the ―antipsychiatry‖ critique has been absorbed into mainstream psychiatric thinking and practice. Psychiatry is generally practiced in the community in a multidisciplinary, biopsychosocial fashion, and psychiatrists themselves lobby for extra resources to achieve this. Government policies enshrine the concept of patient-centred care that meets holistic needs and aims for ―recovery‖ that goes beyond the simple alleviation of symptoms (Expert Group on Mental Health, 2006.) Compulsory treatment of those diagnosed as mentally ill is surrounded by tight regulatory control in Western societies. However, for the most thoroughgoing anti-psychiatrists favour not tighter controls on compulsory admission, but the complete abolition of the phenomenon.One of the most influential critiques is that of Szasz (Szasz, 1960). 1.12.4.1 Szasz disclaims the label ―antipsychiatrist‖ and also insists he is not a philosopher, however his work could be seen both as the quintessence of ―antipsychiatry‖ and as having a strong influence on philosophical approaches to mental illness. Throughout his career he has stated emphatically that illness requires the presence of a physical lesion which causes disease. With mental illnesses, there is no identifiable physical lesion. Therefore ―mental illness‖ is a myth. This is not to say that the phenomena described as mental illnesses are not actually happening, but that they are not illness. ―Mental illness‖ involves a value judgement, whereas the diagnosis of bodily illness does not. What has formerly been termed mental illnesses are in fact ―problems of living.‖ This leads Szasz to a radical and continuing critique of psychiatry as a discipline (Schaeler, ed, 2004.) This subject is discussed in 100s of articles in cyberspace and I leave it to readers with the interest to follow the subject-up in detail. 1.13 This is a useful juncture to say a few things about co-dependency. Codependency is, at it's core, a dysfunctional relationship with self. We do not know how to love our self in healthy ways because our parents did not know how to love themselves. We were raised in shame-based societies that taught us that there is something wrong with being human. The messages we got often included that there is something wrong: with making mistakes; with not being perfect; with being sexual; with being emotional; with being too fat or too thin or too tall or too short or too whatever. As children we were taught to determine our worth in comparison with others. If we were smarter than, prettier than, to receive better grades than, faster than, etc. - then we were validated and got the message that we had worth. In a codependent society everyone has to have someone to look down on in order to feel good about themselves. And, conversely, there is always someone we can compare ourselves to that can cause us to not feel good enough. 1.13.1 Codependency could also be more accurately called outer or external dependence. The condition of codependence is about giving power over our self-esteem to outside sources/agencies or external manifestations. We were taught to look outside of ourselves to people, places, and things; to money, property and prestige, to determine if we have worth. That causes us to put false gods before us. We make money or attain some degree of achievement or popularity or material possessions or the "right" marriage and these things are a type of higher power that determines if we have worth. We take our self- definition and self-worth from external manifestations of our own being so that looks or talent or intelligence become the Higher Power that we look to in determining if we have worth. It seems to me that everyone is, to some extent, co-dependent, and for this reason
  • 20. I have included this brief discussion here in my BPD account. For a comprehensive overview of the nature of co-dependency go to this link:http://www.survivingbipolar.com/green_codependence.htm 1.13.2 In the DSM-4(1994), and in the DSM-5(2013), it is much easier to get a diagnosis of BPD. Allen Frances, a critic of both the DSM-4 and the DSM-5, says that this ease, this extension, this widening of the definition and criteria for diagnosis, has created an incredible opportunity for drug companies. "Drug companies got indications for treating BPD," Frances says. "Not just with mood stabilizers, but also with the newer antipsychotic drugs. And they began very intensive ubiquitous advertising campaigns. The rates of BPD have doubled since the early 1990s. Many people have now had too much antipsychotic and mood stabilizing medicines. And these aren't safe drugs." "If diagnosis can lead to over-diagnosis and overtreatment, that will happen. Doctors need to be very, very cautious in making changes that may open the door for a flood of fad diagnoses." As far as Frances is concerned, the new DSM-5 is proposing too many diagnoses that are written in too broad a way, meaning that ultimately a huge number of new people will be categorized as mentally ill. But there are others, many, who do not agree with Frances. They see this new definition of BPD as an enabling process so that those who would not otherwise get treated will. 1.13.3 Since 1952, the Diagnostic and Statistical Manual of Mental Disorders, better known as the DSM, has been providing brief descriptions of each psychological malady said to afflict a patient. This bible of mental health treatment is published by the American Psychiatric Association (APA). Over the decades, the manual, adapted from a guide for mental diseases developed by Army and Navy psychiatrists, has ballooned. The number of listed disorders tripled to nearly 300. A few have been discredited and dumped along the way. As the task force producing DSM-5 posted drafts on its website: http://www.dsm5.org/Pages/Default.aspx an undercurrent of dissatisfaction exploded into a full-scale revolt by members of U.S. and British psychological and counselling organizations. The chief complaint is that the newest version will lower the criteria needed to diagnose some conditions, creating ―sub-threshold‖ disorders, and generally making it easier for healthcare professionals to label a person with a psychiatric disorder and medicate him or her. 1.13.4 Should a future DSM, however, adopt softer criteria, we may well see bipolar disorder broken down not only into I and II, as it has been since the 1994, but also bipolar III, IV, and maybe even V. We are talking about a multipolar phenomenon. A Dr Akiskal has been the main proponent of an expanded definition of BPD, one that would incorporate a good deal of the current unipolar population. Dr Akiskal has pointed out that many patients with so-called unipolar depression exhibit certain hypomanic (mild mania) symptoms. Though these symptoms may not add up to an actual hypomanic episode, Dr Akiskal maintains they constitute sufficient evidence of bipolarity. He thus has urged that this population be diagnosed accordingly. Even the best psychiatrist in the world is only as good as what you tell him or her, and his own knowledge base and set of biases. As well as confiding to your psychiatrist about how miserable you are, you should come prepared to talk about those times you felt agitated and irritable and even a little hyper. In other words, give your psychiatrist something to work with. The profession is still learning, but even a marginal improvement in outcome can make all the difference in the world, insofar as these factors are taken into consideration.
  • 21. Go to these two links for more information: http://www.mcmanweb.com/multipolar.html and http://www.salon.com/2011/12/27/therapists_revolt_against_psychiatrys_bible/singleton/ 1.13.5 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. 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. 1.13.6 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 BPD, 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.‖ 1.13.7 This problem of language is dealt with at the following link:http://www.healthyplace.com/blogs/breakingbipolar/2010/06/are-bipolars-crazy-i- am/ I like the word 'crazy' which the author of the above blog emphasizes and uses in her daily life with others. But the word, 'crazy' like 'mentally ill' or even such terms like 'mental health problems/issues', have their downside. In some ways, the problem raised is one of language. There is a world of language associated with attempts to describe one's experience with BPD over the short term or over a lifetime. There is the problem of the 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. Language is a problem not only with respect to mental illness but also with respect to many other complex problems in society. KISS, keep it simple stupid, does not solve all problems. Whom the gods would
  • 22. destroy they first make simple and then simpler and then simplest. I will leave this problem here. 1.13.8 The term "Mental Illness" encompasses a wide range of conditions that have to do with the way the mind operates. Some of these conditions are caused by physical dysfunctions of the brain. Some are caused by various forms of emotional and psychological trauma. Some are primarily cognitive in nature. Some are primarily emotional in nature. 1.14 BPD presents particular challenges with regard to assessing response to therapy. Criteria for determining remission and recovery have been suggested for mood disorders, but the clinical usefulness of these terms in BPD is elusive. Formal psychological rating scales may be impractical in a routine medical practice setting. As an alternative, clinicians might probe for information about particular "signal events," such as sleep disturbances, that may herald mood fluctuations. The ultimate goal of bipolar management should be complete and sustained remission, whenever possible, although most patients will not achieve this status for any significant length of time. As I write this at the age of 69 sleep is still a problem: I spend 10 to 12 hours in bed daily, and get 8 to 9 hours sleep daily, on average. Often, although not always, two of these hours are in the day and evening. The side effects of each of the two medications I take include drowsiness(seroquel and effexor). After a meal I nearly always feel a need to have a sleep or rest; after two hours of human-interaction sleep or rest is also needed. 1.14.1 People tend to sleep more lightly and for shorter time spans as they get older, although they generally need about the same amount of sleep as they needed in early adulthood which, in my case, was 8 hours. About half of all people over 65 have frequent sleeping problems, such as insomnia. Deep sleep stages in many elderly people often become very short or stop completely. This change may be a normal part of aging, or it may result from medical problems that are common in elderly people. It may also result from medications and other treatments for those problems. For an excellent overview of the topic of sleep and bipolar disorder go to this link: http://www.survivingbipolar.com/green_sleep.htm 1.14.2 Overaggressive management might entail pushing medication doses to intolerable levels. Individual treatment goals should always take into account patient acceptance of the side effect burden, allowing for trade-offs between treatment effect and quality of life. Noncompliance with therapy, notoriously common among patients suffering from BPD, can stem from drug side effects, treatment ineffectiveness, or even treatment success if the patient misses the manic symptoms. Despite effective treatment, relapse is common. Realistic treatment goals should strive for sustained symptom abatement while maximizing patient quality of life from visit to visit. Ineffective therapy is disturbingly common. Therapy for the BPD in my life has been a complex and somewhat tortuous process with sometimes steep, sometimes very gradual, and seemingly non-existent learning curves. 1.14.3 According to a 2010 study published in the American Journal of Psychiatry, 42 percent of people in psychotherapy use 3 to 10 visits for treatment, while 1 in 9 have more than 20 sessions. A recent study by the National Institute for Health and Welfare in Finland found that ―active, engaging and extroverted therapists‖ helped patients more quickly in the short term than ―cautious, nonintrusive therapists.‖ More than an oasis of
  • 23. kindness or a cozy hour of validation and acceptance, most patients need smart strategies to help them achieve realistic goals. As the years have gone on, the decades of treatment regimes, it is this that I have come to seek in my psychiatrist. To see more on this subject go to this link: http://www.nytimes.com/2012/04/22/opinion/sunday/in-therapy-forever- enough-already.html?ref=mentalhealthanddisorders 1.14.4 Some patients are unable or unwilling to step into the difficult and uncharted explorations that treatment for BPD and other psychiatric and psychoanalytic work entails. I had this problem, off and on, from 1968 to 1991. Each psychiatrist I had over the years made his effort to establish analytic contact and a therapeutic relationship. This was important to me in obtaining a level of valuable support, containment of my problems, and growth in dealing with my illness. Some patients, and I was certainly one during the quarter century from, say 1968 to 1992, may display great resistance to the challenge of psychiatric and psychoanalytic treatment. I was not what psychiatry calls "a turbulent patient," but I did have trouble with complaince. I never left treatment in a very abrupt and unprocessed manner, but I often would have liked to do so. For many their treatment is suddenly all over and that is that. This abrupt dismissal is usually a continued expression of their remaining pathology and the presence of conflictual phantasies that had been played out throughout the span of their treatment and the analytic process. This cannot always be prevented. 1.15 My wife, Chris, has suffered from different disorders and health problems 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 way 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, in passing in my elaboration of my experience of BPD. 1.15.1 "Spirituality" as I define it here, is the basic feeling of being connected with one's complete self, others, and the entire universe. If a single word best captures the meaning of spirituality and the vital role that it plays in people's lives, that word is "interconnectedness." Spirituality should not be treated as a jargon to find place in philosophical books but it encapsulates the very essence of practising life with simplicity and being aware at the same time, of the immense complexity of life. Spirituality in the workplace can be of great help in increasing the productivity of each individual and organization in totality. In contrast to religion that is organized and communal, spirituality is highly individual and intensely personal. One doesn't have to be religious in order to be spiritual. A values-based organization results when the founders or heads of that organization are guided by general philosophical principles or values that are not aligned or associated with a particular religion as is the case with the vast majority of secular institutions: state and government, schools and hoispitals, inter alia.
  • 24. In the changing business scenario there is a need to integrate spirituality into management. No organization can survive for long without spirituality and soul. Ways of managing spirituality without separating it from the other elements of management need to be understood and implemented for the holistic development of individuals and organization. The importance of practising spirituality in the workplace for that workplace to progress from cognitive intelligence to emotional intelligence and ultimately to spiritual intelligence which acts as a catalyst for inspirational leadership and management excellence is importnat for mental health. I have drawn on Rekha Attri's article "Spiritual Intelligence: A Model For Inspirational Leadership," in the International Journal's Research Journal for Social Science and Management, Vol. 1, No.9, 2012, for this concept. 1.15.2 A growing literature suggests that clinicians should consider the religion or spirituality of their patients as part of the psychiatric evaluation, one more piece of the puzzle that makes up the person, whom we try to understand as well as possible so we can provide help to the best of our ability. Studies to date have suggested three conclusions, all of which can be debated: 1) individuals with no religious affiliation are at greater risk for depressive symptoms and disorders, 2) people involved in their faith communities may be at reduced risk for depression, and 3) private religious activities and beliefs are not strongly related to risk for depression. Depression has been the most frequently studied of the psychiatric disorders in relationship to religion or spirituality, in large part because of the overlap in expression of both. For example, guilt associated with depression often is connected with a religious belief system, and apparent depressive symptoms (such as the ―dark night of the soul‖) are associated with religious experiences. For more on this subject go to this link:http://ajp.psychiatryonline.org/article.aspx?articleid=181239 1.16 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. 1.17 This account also provides a statement of my most recent experiences with BPD in the last five years, 2007-2012. 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 90,000 words, is an outline, a description, of this partially genetically predisposing family-based illness and of my experience with it throughout my life. 1.17.1 I would, though, discourage others from blaming their parents for their genetic
  • 25. contribution to the disorders. I would also discourage them from blaming other family members for their contributions in the form of psycho-social 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. 1.18 Some of the personal context for this illness over the lifespan in my private and public life, in the relationships with my consanguineal family(family of birth) and in my two affinal families(families by marriage), in my employment life(1955-2005) and now in my retirement(2000-2013) are discussed in this document. I include in the description and analysis of my BPD some of what seems to me my major and relevant life events, not as triggers in my experience of BPD but as accompanying factors: (a) personal circumstances as they relate to my values, beliefs and attitudes--what some might call my religion as defined in the broad of senses; (b) family circumstances; for example, my parents‘ life, my wife‘s illnesses, the life-experiences of my three children as well as significant others in my lifespan like my father and mother and my first wife; (c) employment circumstances involving as they did: (i) psycho-social stress, (ii) movement from place to place and (iii) my sense of identity and meaning; (d) aspects of day-to-day life and their wider socio-historical setting and (e) details on other aspects of my medical condition to help provide a wider context for this BPD in the last two years. 1.18.1 I could explore section (d) above in some detail, but to be brief, let me simply add here that: processes of social inequality, poverty, human exploitation, besides many other ideological processes, install emptiness, disempowerment and lack of meaning in life. This is a frightening discovery because if we assume that this constitutes illness, the treatment for psychopathology should be a lot more complex than what have been traditionally used in clinical psychology and in psychiatry. It should give priority to political and community processes which help to make it possible and preserve mental health in addition to any neurobiological processes. 1.19 This lengthy account will hopefully provide mental health sufferers, clients or consumers, as they are now variously called these days, with: (i) a more adequate information base to make some comparisons and contrasts with their own situation, their own predicament, whatever it may be, (ii) some helpful general knowledge and understanding, (iii) some useful techniques in assisting them to cope with and sort out problems associated with their particular form of mental health problem or some other traumatized disorder that affects their body, their spirit, their soul and their everyday life and (iv) some detailed instructions on how to manage their lives more successfully despite the negative consequences of their BPD or whatever trauma or illness affects their lives. I am registered at over 100 mental health sites and contribute in ways that seem appropriate. But I do not assume the role of coach or mentor on the internet as some doctors, specialists and people who have experienced various forms of mental illness do at many sites on the world-wide-web. 1.19.1 Conventional research into mental health disorders is based on the assumption that professionals are better equipped to interpret the experience of sufferers because of their distance from the experience of the sufferers. It is perhaps now time for mental health service users to question the assumption that the greater the distance there is
  • 26. between direct experience and its interpretation, the more reliable it is. Such an approach explores instead the evidence and the theoretical framework for testing out whether: the shorter the distance there is between direct experience and its interpretation then the less distorted, inaccurate and damaging resulting knowledge is likely to be." For an interesting discussion of this topic go to this link: http://www.qualitative- research.net/index.php/fqs/article/view/1790/3311 1.20 I like to think that what has become over the last few years this book of 160 pages has advice that could be used by many people with BPD as well as others without BPD. Keeping detailed records, for example, written or mnemonic, ingrained in memory and/or with signs for immediate recall when required--of one‘s feelings and relationships and, in the process, taking responsibility for maintaining and improving them, might help BPD sufferers and others deal with their problems and have more successful lives. As for the meaning of successful, I prefer Thoreau's evocative lines: "If the day and the night are such that you greet them with joy and life emits a fragrance like flowers and sweet- scented herbs; if life is more elastic, more starry and more immortal in the process--that is your success." Even ‗Abdu‘l-Bahá‘s ‗oft repeated phrase: ―Be Happy!‖ is a simple enough aphorism and yardstick for measuring your daily life, your sense of well-being and the extent to which you are well-oriented and well-positioned to assume the responsibilities that are the result of your interests and commitments. Of course, in using such definitions of ‗success‘ like this, one must recognize that millions of people without mental health issues don‘t have success defined in these terms. Finally, success and happiness are highly idiosyncratic terms and how each person sees them, defines them and experiences them are their own--even if there are many common threads from person to person. 1.21 There are two kinds of lists that BPD sufferers need to keep in mind in going about their daily lives in dealing with this disorder. So wrote one writer and, liking what he wrote, I include his ideas here. The first list is what you could call risk-factors that increase the chances of BPD sufferers becoming ill and/or having their symptoms dominate their daily life and produce ill-effects for themselves and others in their environment. Such socio-environmental factors as: family distress, psycho-social stress, drinking alcohol or using drugs, sleep-deprivation or missing medication are in this category. A second list of what could be called protective factors help to protect people with BPD from becoming ill, from having an exaccerbation of their symptoms. They include: keeping charts of one‘s moods and sleeping patterns, going to bed and getting up at the same time every day, staying on one‘s programs/regimes of medication and psychotherapy and avoiding psycho-social stressors that one knows will precipitate negative symptoms of BPD. 1.22 My note-taking and list-making are works-in-progress so to speak, and have been for years. How they are implemented varies from year to year and decade to decade. Now, at the age of 67, I keep: (a) a medical file in 5 sections in a separate briefcase. Readers can see the outline of this file in Appendix 7; (b) this 95,000 word and 160 page book updated to outline my life-experience of BPD; and (c) a written autobiography in 5 volumes which I update, as well as 1000s of prose-poems. I continue to write poetry each week. All of this helps me monitor my experience of BPD both directly and indirectly. I have used many charts, made many plans and tried to implement various safety-nets over my lifetime. Freeman‘s description of the ones BPD sufferers can use is the best I‘ve seen.
  • 27. 1.23 I like to think that this account is crammed full of useful information for patients with BPD and other illnesses, for their family members, for therapists, for friends, lovers, employers and anyone else interested in BPD. The insights I share were not acquired by reading the voluminous literature on BPD, although I have taken a serious intellectual interest in the subject in the last decade since I retired from FT employment in 1999. My insights come, in the main, from reflecting on 69 years of life since my conception in October 1943. 1.23.1 I have benefited from what you might call the collective wisdom of others about what it means to live with BPD and other conditions. This wisdom comes from the reflections of other writers, from specialists, indeed a range of commentators. Finding solutions to my BPD problems and telling about what works for me taps into my creative resources and it also requires investigating my own trial and error efforts to create a personally satisfying life in order to separate what works from what doesn‘t work. Finding solutions and what works in one‘s own life is a form of artistry that can result in highly individual and unique solutions and outcomes. I like to think that this book taps into both my own wisdom and experience and the collective wisdom of others looking for a better quality of life by writing about what has been helpful for them as sufferers with BPD or some other condition or, indeed, as a loved one or family member. The medical psychiatric perspective believes in the centrality of genetic and biological approaches to mental ill-health over psychosocial ones and, at least in my case, this perspective informs this account. To put this idea another way, this account is based on the psychiatric perspective of the centrality of genetic and biological approach to mental health. 1.24 There are other psychiatric disorders often confused or associated with BPD and sufferers with BPD need to be aware of these other disorders in their diagnostic dialogue with their doctor and as they go about negotiating their lives. Differential diagnoses, as they are sometimes called, include: ADHD, schizophrenia, obsessive-compulsive personality disorder; recurrent major depressive disorder, schizo-affective disorder, post- traumatic stress disorder, narcissistic personality disorder, borderline personality disorder, antisocial personality disorder, avoidance disorder and cyclothymic personality disorder. I have many of the features of any one of these disorders except schizophrenia at one time or another in the last seven decades. I was officially diagnosed by a psychiatrist in 1968 as having schizo-affective disorder. All of the other disorders I can partly, indeed, significantly, identify with when I read the list of symptoms associated with each of them. I would not list these disorders here if I did not exhibit or have not exhibited many of their symptoms in my lifetime. 1.24.1 In one study of 60 patients with BPD, 23 (38%) fulfilled the diagnostic criteria for at least one personality disorder. Those personality disorders most commonly were: narcissistic, borderline, antisocial, avoidance disorder and obsessive-compulsive. In my case the obsessive-compulsive personality disorder(OCPD) and post-traumatic stress disorder(PTSD) have been the most dominant; I can now see looking back over seven decades of living, 1943 to 2013, periodic manifestations of both OCPD and PTSD at various points in my life-narrative. The presence of these other disorders sometimes make BPD symptoms more intense and more difficult to treat; they also appear to increase the risk of suicide. I will deal with my suicidal ideation later in this account of
  • 28. my chaos narrative. This account is about BPD, by a person with BPD. My account only ventures into these several other psychiatric illnesses and personality disorders to a limited extent, and only from time to time when it seems relevant. I will deal with these personality disorders in my life briefly in the next several sections before continuing this account of BPD. 1.24.2 A personality disorder is an enduring pattern of inner experience and behavior: (a) that deviates markedly from the expectation of the individual's culture, (b) that is chronic, pervasive and inflexible, and (c) that affects two or more of the following areas: thoughts, emotions, interpersonal functioning and impulse control. To be considered a personality disorder the behaviour should also have an onset in adolescence or early adulthood, that is the years 20 to 40, be stable over time and lead to distress or impairment. Because these disorders are chronic and pervasive, they can lead to serious impairments in daily life and functioning. 1.24.3 In a list of ten basic symptoms of obsessive-compulsive personality disorder(OCPD), I possessed six symptoms rated at 5 or above on a 10 point scale in January 2010. I will not list these symptoms of OCPD here since this narrative and analysis is a focus on BPD, but readers can easily Google OCPD, if they are interested. Wikipedia is an informative source for information on OCPD. The pattern of behaviours for my OCPD has been highly diverse rather than stable over the years as far back as my childhood and has become more dominant, as I say, in my late adulthood, the years after the age of sixty on a new medication regime of an anti-depressant and an anti-psychotic. I will discuss this new medication regime in more detail later in this story. People with OCPD are ridden with anxiety. This overstates my level of anxiety. By contrast, people with OCPD tend to derive pleasure from their obsessions or compulsions. This is the case with me. 1.24.3.1 The primary symptoms of OCPD are: (i) a preoccupation with details, rules, lists, order, organization, and schedules; (ii) showing a perfectionism that interferes with the completion of a task, (iii) excessive focus on being productive with time and (iv) excessively devoted to work and productivity to the exclusion of leisure activities and friendships. People with OCPD, when anxious or excited, may tic, grimace, or make noises, similar to the symptoms of Tourette syndrome or do impulsive, and unpredictable things. Children are sometimes born with a genetic predisposition to OCPD, but may never develop the full traits. Windows of vulnerability to stress exist across human cortical development and this has: (a) a critical role in determining the brain's capacity to respond to stress, and (b) has been implicated in the pathogenesis of psychiatric illness. The neonatal and infant period, specifically the period less than 130 days, and the late adolescent periods represent critical windows of stress pathway development. I could comment in more detail here, and I do later in this account, on my pre-natal and neo-natal experience and its role in the etiology of my OPCD as well as BPD. Looking back to my early childhood there is some evidence that I had OCPD. The literature suggests that much depends on the context in which such children are raised. Since anxiety, trust and everyday routines of social interaction are so closely bound up with one another, it is easy to understand how the rituals of day-to-day life become a type of coping mechanism. Small children love ceaseless repetition, and frequently act in
  • 29. ways that in an adult would be regarded as obsessive and compulsive, patterns that normally fade with growing maturity. Especially in the Freudian tradition, seriality and repetition are signs of immaturity that require suppression. My first memory of ceaseless repetition was drawing 100s of tulips. This may not have had anything to do with OCD as a child. 1.24.3.2 Therapists dealing with clients who have BPD often discover gaps in the personal narratives of their patients. The first five years of life are generally lost to the veil of infantile amnesia, and utterly unlikely to be recovered even in the deepest and longest psychoanalytic treatments. In my case this infantile amnesia certainly applies. Freud indicated that therapist and patient might like to try to fill those gaps with ―constructions,‖ conjectures, or hypotheses on what might have happened. Despite Freud‘s endorsement of the procedure, reconstructions were neglected until the 1970s forward. If controversial in psychoanalysis, constructions have been neglected in short- term psychoanalytic psychotherapy; it is, literally, a construction zone. The focus is on ―clarification of experience‖ and not ―repressed memories.‖ I have done this to some extent in this account of my life with BPD. 1.24.4 I was diagnosed with a mild schizoaffective disorder in the autumn of 1968. After six months(6/68-11/68) in four different psychiatric wards and hospitals I was eventually released. I also took anti-depressants luvox(fluvoxamine-2001) and then effexor(venlafaxine-2007) for depression. The side-effects from these anti-depressants, which I manifested in the years 2001 to 2012 were: sleepiness,(especially after a meal and after 2 hours of interaction) fatigue and weight gain. Less common side-effects that have been manifest in my day to day life include: gas, difficult or laboured breathing, some loss of touch with reality, increased awareness, neck pain, vertigo, diarrhoea, heartburn, abnormal dreams, unusual tiredness and social withdrawal symptoms. Often, when I watch TV for 5 to 10 minutes I get sleepy and either go to bed or do some reading to activate my brain. 1.24.4.1 The luvox and effexor helped decrease the intensity of the depressions which I had been experiencing late at night for 20 years. For patients with the most severe forms of depression, and mine was severe in the hour before going to sleep, the benefit of an anti-depressant over a placebo was substantial. The opposite of depression is not happiness, but vitality, and my life, as I write this, is vital, except for a trace of that depression on going to bed. See an article on this subject at: http://www.nytimes.com/2012/04/22/magazine/the-science-and-history-of-treating- depression.html?pagewanted=4&ref=mentalhealthanddisorders The sense of relief from the intensity of that late-night depression was a source of positive energy, a wonderful injection of spirit and joy into my life. The significance of the depressed phase of BPD has been markedly underestimated not only by those familiar with BPD but by the wider society. Bipolar depression accounts for most of the morbidity and mortality due to this illness. Millions of people around the world embraced antidepressants beginning in the 1980s. By the time I first took an anti- depressant in 2001, anti-depressants were becoming all the rage and slowly becoming the third-most-common prescription drug taken in America. Fast forward to 2012, though, and the same antidepressants that inspired such enthusiasm have become the new villains of modern psychopharmacology. They are seen as overhyped, overprescribed chemicals, symptomatic of a pill-happy culture searching for quick fixes
  • 30. for complex mental problems. Depression is a complex, diverse illness, with different antecedent causes and manifestations. As the clinical trials show unequivocally, only a fraction of the most severely depressed patients respond to serotonin-enhancing antidepressants. Do these patients respond because their depression involves cellular death in the hippocampus? Our current antidepressants are thus best conceived not as medical breakthroughs but as technological breakthroughs. Anti-depressants are chemical tools that have allowed us early glimpses into our brains and into the biology of one of the most mysterious diseases known to humans. 1.24.4.2 Still after more than 12 years on first luvox(2001) and then effexor(2007) I see them in retropsect as helpful. In April 2012 I went off these meds and took a new cocktail.This story is found below. 1.24.5 Narcissistic personality disorder (NPD) is a personality disorder defined by the Diagnostic and Statistical Manual of Mental Disorders, the diagnostic classification system used in the United States. Although I do not fit the narrow definition of NPD: "a pervasive pattern of grandiosity, need for admiration, and a lack of empathy," it could be argued that I am excessively preoccupied with self-centeredness, and issues of personal adequacy, power, and prestige. In the list of diagnostic criteria, there is no doubt that I have an element of NPD. As is the case with any personality disorder, the details are complex and require much discussion if they are to be teased-out and understood. The extent of my NPD is only partial like so many of the personality disorders associated with BPD, and self-diagnosis is often problematical in a host of ways. 1.24.5.1 There are several sub-categories of narcissism or narcissistic personality disorder and the one I come closest to exemplifying is the amorous narcissist with its emphasis on the erotic and exhibitionism. I may have had an oversensitive temperament at birth; I was certainly overindulged and excessively admired and praised as a child and adolescent, although I may be overstating the case. Life for those living with a person who has NPD can be very difficult indeed, formidable and isolating. My wife has often expressed this view. When people with NPD are criticized they often feel rejected, humiliated and threatened in the context of their ambitious and capable selves. A hypomanic mood can be coupled with a sense of grandiosity. NPD is sometimes seen as a defence against shame. I seem to exhibit some of the characteristics of the many sub- types of narcissism. I also utilize some of the narcissist‘s coping strategies. NPD commonly coexists with: hypomania, histrionic PD, borderline PD, antisocial PD and paranoid PD. I have aspects of all of these personality disorders. NPD is not due to a chemical imbalance but, rather, is an ingrained personality trait. Since some narcissistic traits are common and normal; since self-love is part of the very clay of man, I find it difficult to assess the real extent of NPD in my life. 1.24.5.2 A. M. Benis(1939--), now a retired physician, developed what is now called the NPA theory of personality on the basis of the concepts of psychiatrist Karen Horney(1885-1952). This trait theory of personality posits that narcissism is one of the three major behavioural traits underlying personality and human character. It is indispensable, so goes this theory, to human development. I advise readers to read about this theory if they want more detail on the nature of narcissism and what is, in many ways, a naturally occurring trait in all people or which, in some respects, I am one.
  • 31. 1.24.5.3 There are also a range of other personality theories and tests that provide a context within which people with BPD, and anyone else for that matter, can view themselves. I have provided one such context in Appendix #3, a context in which I have typed myself as a sanguine-melancholy personality. 1.24.6 Antisocial personality disorder (ASPD or APD) is defined by the American Psychiatric Association's Diagnostic and Statistical Manual as "a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood." The individual must be age 18 or older, as well as have a documented history of a conduct disorder before the age of 15. People having antisocial personality disorder are sometimes referred to as "sociopaths" and "psychopaths", although some researchers believe that these terms are not synonymous with ASPD. Impulsivity, superficial charm, inflated self-appraisal, irritability leading to aggression, disregard for social norms and extensive rationalization of one‘s behaviours all characterize ASPD. I have had all of these traits at one time or another and sometimes many of these traits at once. 1.24.6.1 Readers are advised to go to the online encyclopaedia, Wikipedia, to get a fuller picture of the various mental disabilities I refer to in this account. It is possible, or at least one could argue, that I do not fall into these categories in even a minimal sense. I have certainly never been diagnosed by a psychiatrist and treated for other disorders. BPD is the only label which has stuck since 1980. It is important to include a note of warning here, namely, that: once one goes trolling among the pages of disorders, mental and otherwise, that exist in the medical and psychiatric literature, one can find all sorts of data that applies to one. 1.24.7 Cyclothymia is a rapid-cycling form of bipolar affective disorder which creates alternating short periods of hypomania and depression, with periods of stability in between. Cyclothymia is often regarded as the poor cousin of BPD, but should not be underestimated. It is a very serious condition that needs long-term management and support for the sufferer and the health care professionals who deal with the sufferer. Cyclothymia is a milder form of BPD. Like BPD, cyclothymia consists of cyclical mood swings. However, the highs and lows are not severe enough to qualify a mania or major depression. 1.24.7.1 To be diagnosed with cyclothymia, a person must experience at least 2 years during which they have had frequent hypomanic episodes and depressive mood swings that do not meet criteria for major depressive or manic episodes. I experienced cyclpthymia for the first time in the years 1963 to 1967. Because people with cyclothymia are at an increased risk of developing full-blown BPD, it is a condition that should be monitored and treated. My four years at university, 1963-1967, could be said to be a form of untreated cyclothymia. The famous English actor Stephen Fry says his BPD is of this variety which he likens by analogy to a temperate English climate as opposed to the more severe climates in the world which, again by analogy, are like the full-blown BPD. In the USA Fry says that this variety of BPD is known as light BPD. In 1968 I experienced a full-blown BPD episode, although it was given the label ―a mild schizo-affective state.‖ 1.24.7.2 Looking back over seven decades of BPD, I would say that I experienced mania
  • 32. and psychosis—a chemical imbalance in the brain. This psychosis was like a detonation. It took place in someone who had exhibited absolutely no symptoms previously, in a person who had led a normal life until that psychotic episode shattered my normalacy. It presented itself as energy of a primordial sort. One writer likened it to ―being in the presence of a rare force of nature, such as a great blizzard or flood: destructive, but in its way astounding too.‖ Such unbridled energy can resemble that of creativity or inspiration or genius—this, indeed, is what I felt rushing through me. In retrospect it was clearly experienced as an illness. It is not accurate, at least in my case, to describe the experience, as some do, as the apotheosis of health. There was, it could be said, a release of a deep, previously suppressed self. That was part of the good side. This story of BPD tells for the most part the bad side, although I also express some of the positive aspects of BPD. The experience of high energy and creativity are equivalent to a full-blown psychopathology, to a clinical manic episode which, by definition, entailed significant impairment. 1.24.7.3 Some people with BPDII say that they need their highs in order to enjoy life and to feel good about themselves. BPDI sufferers like myself never feel alive during these manic highs. The manic episodes of which I have had two in my life are so disorienting that I would never say I need them. Some BPD sufferers prefer to have their problems if that is the price they have to pay for their mania, their severly elevated moods. Normality or evenness of mood, for such people, is like living at low altitudes. They want to fly, so to speak. They reject drugs because the drugs often make their hands shake. Pharmacological treatments are often not effective because of problems with adherence and compliance. 1.24.7.4 In my retirement years, 1999 to 2013; and disability and old-age pension years, 2001 to 2013, my cyclothymia or BPD, was treated. The BPD I suffered after the age of 35(in 1980), or 55(in 1999) was BPD I. This BPDI, during the 5 years I was on sodium valproate and effexor(4/07 to 4/12) was characterized by: lack of interest in socialising, except to a minimal extent, the need for a very large amount of sleep(although only an average of 8 to 9 hours in a 24 hour period), not wanting to get out of bed(therefore spending 10 to 11 hours in bed for 8 hours sleep), difficulty in holding down a regular job, relationship issues and financial troubles. The death wish and associated feelings continued, as they had done since 1963 and more often after 1978, but, with the new meds, the Black Dog was not as black. I managed my BPD during these retirement years reasonably well and my wife and I enjoyed a decent standard of living. At the age of 69 my wife and I received two pensions totalling $1100 per fortnight(circa). The house my wife and I lived in was paid for and valued at $300,000(circa). By the time I was 69 I had no debt and had about $10,000 left of a reverse mortgage taken-out in 2012. I mention this financial aspect of my present state because money is life blood or bed-rock for a person with BDP, as it is for anyone else. I have not gone into the details of my financial state for the previous years of my life in this account, but in this latest edition it seemed an appropriate item to add at least briefly. 1.25 The economic impact of BPD can now be measured in the hundreds of billions of dollars in the OECD countries(Science Daily, Pittsburgh, 2005). Some 80% of people who have BPD do not even realize that they have BPD and, of those who do, a great percentage do not seek treatment. Of those who do, like myself, time, hours and even years lost in FT employment can be many. In my case perhaps as many as a dozen. I was unemployed in the last half of 1968, two-thirds of 1980, and from 1999 to 2009 at the
  • 33. age of 65 when I went on an old-age pension. By 1999, at the age of 55, I experienced the difficulty in remaining in FT employment and a minimum of financial troubles followed due to just having a disability pension to live on after decades of full-time employment. 1.25.1 By the age of 69 in 2013 I had $3000 in investments, a home valued at $300,000(circa), furnishings insured for $20,000, a 24 year old car valued at $1000(circa), and some $10,000 left in a $20,000 reverse mortgage. My financial stringency came as a result of: (a) my early retirement from FT employment in 1999 at the age of 55, and (b) not saving and/or investing more money over the decades of my employment in preparation for my retirement. In the train of the financial pressure I refer to briefly above, the change in my life-roles, and mutual health problems, came relationship issues with my wife. A new range of personal tests also emerged. There is always the problems of life-experience but, in the main, I do not refer to them in this now extensive account. People wanting to read about the larger content and context of my life, in what is now a five volume 2600 page work, can go to Baha‘i Library Online in a work entitled: Pioneering Over Four Epochs: Parts 1 to 3. 1.25.2 In the first dozen years of my retirement, 2000 to 2013, I had two major, and four minor, medication regime changes. Discontinuation or changing medications is a major problem in BPD treatment. The problems involve efficacy, safety, and tolerability considerations. 1.26.1 In some ways, of course, one cannot-should not complain since there are millions, indeed, billions of people now with relationship issues and who are far worse-off financially than I now am and have been in the last decade. I only mention these financial issues since they have been tangentially connected with my BPD experience in the last decade, since I was 55. I do not want to leave any lingering impression that my wife and I are tottering on the edge of divorce. Our marriage is secure and we will go the distance until one of us dies in our 70s and beyond. 1.27 Over the last several decades I have suffered from a highly varied and sometimes cyclical pattern of highs and lows. They are difficult patterns to define, to understand and, therefore, to seek out and obtain a diagnosis and treatment. Perhaps by the first decade of this third millennium, that is, by 2001, I had come to have what was then called Bipolar Disorder NOS, sub-threshold BPD. I seemed to be suffering from bipolar spectrum symptoms, that is some manic and depressive symptoms, but in some ways my symptoms did not meet the criteria for one of the major subtypes of BPD. I could argue that I had the type of BPD known as: BPD NOS, Not Otherwise Specified. Despite not fully meeting one of the formal diagnostic categories, BPD NOS can still significantly impair and adversely affect the quality of life of the patient. After some reflection, and after seeing a psychiatrist in April 2012, it was obvious that I had BPDI and not BPD NOS. 1.27.1 I have mentioned these sub-types of BPD above since I seem to have some elements, characteristics, of these forms of BPD over the last several decades. But I have never been formally diagnosed as having any of these sub-types. By the 1980s the lows in my life had come to be manifested only before going to sleep. The high energy levels of the 1970s disappeared. Those lows seem both in retrospect and prospect to have been, and now are, those depressive episodes in life. But they do not meet the full criteria for a
  • 34. diagnosis of major depression. 1.27.2 These lows have included, though: suicidal thoughts and feelings, lack of interest in the social dimension of life and the desire for more sleep, among other symptoms. The significance of the depressed phase of BPD has been markedly underestimated. I make mention of this fact in my narrative several times because: (a) bipolar depression accounts for most of the morbidity and mortality due to this illness and (b) I found the lows horrific in my pre-medication days. I found my lows horrific in my pre-lithium days, the days before I was given the official psychiatric diagnosis of BPD. The years 18 to 24(1963-68) and 35-36(1979-80) contained those horrific lows. 1.27.2.1 The horror made me wish for death just about continuously for several months. When I had the trauma associated with some of my experiences of student incivility and control issues in classrooms, it does not surprise me that I have had some PTSD since at least 1968, if not before in my childhood due to my father‘s temper. The degree of my exposure to high levels of trauma in childhood is difficult to assess and any conclusions about this childhood experience are hypothetical. Exposure to childhood trauma in the form of witnessing the domestic verbal violence of my father is now recognized as an independent risk factor for suicidal behavior and ideation later in life. 1.28 Post-Traumatic Stress Disorder(PTSD) and borderline personality disorder(or BoPD) commonly co-occur and they often co-occur in the lives of BPD sufferers. Borderline personality disorder(BoPD) has been receiving increased attention within the media over the years. It has been featured in movies such as Girl Interrupted, as well as articles in the New York Times and popular magazines such as O Magazine. I possess five symptoms of borderline personality disorder(I use the acronym BoPD to differentiate it from bipolar disorder‘s acronym-BPD). The symptoms of BoPD that I possessed were as follows, and they have all decreased on my new meds package in the last two years, 2012-13. 1. A pattern of unstable, intense, and stormy relationships where the person may frequently shift between idealizing and devaluing their partner. With the increase in effexor in September 2010 this tendency, which had only been occurring when my effexor levels were too low, or when I was in an argument, has been virtually eliminated. 2. Being impulsive in ways that are problematic or damaging. This makes for a certain inconstancy in living, a certain tendency to take risks, and a vulnerability to addictions. 3. Frequent and intense mood swings. 4. The experience of intense anger and/or difficulties controlling anger. 5. A paranoia that comes and goes as a result of experiencing stress. To receive a diagnosis of BoPD, a person needs to exhibit at least these 5 symptoms from a longer list of others. Of course, as with all mental disorders, only a mental health professional can provide a formal diagnosis of BoPD. BoPD has been found among people with PTSD and vice versa. Why are these two disorders so inter-related? BoPD and PTSD have both been found to stem from the experience of traumatic events. The thoughts, feelings, and behaviours seen in BoPD are often the result of childhood
  • 35. traumas. These childhood traumas may also place a person at risk to developing PTSD. As of 2012, I began to take seroquel which is also used to help those with PTSD. People with both BoPD and PTSD report the earlier experience of trauma as compared to people with just PTSD. My impulsive behaviours and unstable relationships, it could be argued, are evidenced by: (a) a divorce from my first wife, (b) many changes in jobs may be part of BPD. They may have no relationship with borderline personality disorder(BoPD), and (c) a certain inconstancy in living, a certain tendency to take risks, and a vulnerability to addictions. The symptoms of PTSD and BoPD do overlap; for example, individuals with PTSD may have difficulties managing their emotions. Therefore, they may experience intense feelings and have constant mood swings. They may also experience problems with anger. In the last half century 1963 to 2013 I could tick the box for these experiences in my life, but the specific descriptions of my experience in these areas over 50 years would require more than two sentences. to some extent this life-narrative is an account of some of these swings and my experiences of these symptoms. 1.29 This section is concerned with the manifestation of what is called post-traumatic stress disorder(PTSD) in my life. It entered the psychiatric disorder literature the same year as the term bipolar disorder(BPD), that is, in 1980. The overlap for PTSD and BPD, both neuropsychiatric medical disorders, is high. I have only begun to see PTSD as present in my life in the last six years, the years of my present & previous medication package: May 2007 to May 2013.In retrospect,I can see the manifestations of PTSD as early as 1968, if not before. Indeed, this overlap has only been recently described in the publicly and easily assessable medical literature as well—on the internet. 1.29.1 Although most people (50–90%) encounter trauma over a lifetime, only about 20- 30% develop PTSD, and over half of these people(10% to 15%) will recover without treatment. I could easily argue that I have recovered without treatment. Vulnerability to PTSD presumably stems from an interaction of biological-hereditary predisposition, early childhood developmental experiences, and trauma severity. I possess, therefore, a vulnerability to PTSD because all these factors were present in my childhood and adolescence. A person that never established secure relationships and learned coping skills as a young child if exposed to a traumatic experience is more likely to develop PTSD than one that developed good coping skills and has a support network. Since I developed good coping skills and had a support network would suggest I did not develop PTSD. 1.29.2 Predictor models have consistently found that childhood trauma, chronic adversity, and familial stressors increase risk for PTSD as well as risk for biological markers of risk for PTSD after a traumatic event in adulthood. Peritraumatic dissociation, that is, dissociation near the traumatic event, which I had in 1968, is not a predictive indicator of the development of PTSD later in life. Proximity to, duration of, and severity of the trauma do make an impact, as my father's temper did on me. Interpersonal traumas cause more problems than impersonal ones in children; they are a predictive indicator of the development of PTSD later in life. This effect of childhood trauma, which is not well understood, may be a marker for both traumatic experiences and attachment problems.
  • 36. 1.30 We all have a window of tolerance outside of which we behave inappropriately. For healthy individuals, this window is wide. Those with PTSD may seek, focus upon, and over-react to cues even remotely related to danger or trauma, thus constantly reacting as though under threat. Much of the work with traumatized individuals involves helping them with their social interactions when they perceive clues that would take them outside their window of tolerance. I first remember being traumatized:(i) when my father lost his temper from the age of 6 to 16(circa), and (ii) in the years 18 to 24 during the first major episodes of what was then my BPD 2. I now see, or at least I have little trouble hypothesizing, some of my later life-experience as PTSD a result of (a) fear and/or anger in my home as a child, (ii) as well as experience of very intense depression in my late teens, and (iii) traumatic classroom teaching(student incivility and my control issues) among Inuit children in 1967/8 at the age of 23. 1.30.1 The degree of my exposure to high levels of trauma in childhood is difficult to assess and any conclusions about this childhood experience are hypothetical. Exposure to childhood trauma in the form of witnessing the domestic verbal violence of my father is now recognized as an independent risk factor for suicidal behavior and ideation later in life. The abilities that we call upon to respond accurately to novel situations are sometimes referred to as executive functions. They are frequently engaged to deal with conditions in which routine activation of behavior may not be sufficient for optimal performance. Now in the evening of my life it may be that whatever PTSD I have interferes with these executive functions, although much less on my new meds in the last 6 years, as well as on lithium from 1980 to 2007. 1.30.2 A person with PTSD must learn to keep their behavioural and psycho-social orientation flexible and appropriate. They can do this by trying to make their interactions with others characterized by an attitude of curiosity, ease and as free of conflict as it is possible to be. If sufferers from PTSD have some professional trainers or counsellors, they can learn to use biofeedback and neuro-feedback tools. They can be coached to alter their own neurophysiological state when having experiences outside their window of tolerance. With the help of a skilled trainer, sufferers from PTSD can learn to function/behave more appropriately in social settings. They can come to understand that their disturbing reactions are simply reflexes that may have served their purposes in the past, but do not need to be experienced now, do not define who they now are and do not need to determine how they feel and respond in the present. With such psychological counselling, the sufferer from PTSD can learn to tolerate progressively wider windows of arousal. Although I had no such counseling, I have developed greater windows of tolerance as the decades have gone on. 1.30.3 Such counselling helps the PTSD sufferer to frame his experience in a wider, more comprehensive context, thus ensuring a more normal life pattern. In the last three years, as I say, on my new meds and without access to a trainer or counsellor and their biofeedback and neuro-feedback tools, I have been trying to learn: (a) to understand my disturbing reactions when they arise and (b) to frame them in a wider context for effective interpersonal functioning. By relying on what one might call my own impressionistic feedback mechanisms, I try to observe the indications of my physiology, my body language and my emotions going into hyper- or hypo-mobilization from what are usually and essentially minimal reminders of threat. And there have been many of these minimal threats in the last three years: advice, criticism, the perceived
  • 37. aggressiveness and the over-assertiveness of others, inter alia, which resulted in disturbing and inappropriate reactions on my part. 1.30.3.1 Eye Movement Desensitization and Reprocessing (EMDR) is a relatively new clinical treatment that has been scientifically evaluated primarily with trauma survivors. EMDR's originator, Dr. Francine Shapiro, describes the procedure in detail in a recent book, and advises that therapists use EMDR only after completing an authorized advanced training in EMDR. In EMDR a qualified therapist guides the client in vividly but safely recalling distressing past experiences. This is known as "desensitization." Any new understandings gained are part of a process known as "reprocessing." This involves a reprocessing of the events, the bodily and emotional feelings, and the thoughts and self-images associated with them. The "eye movement" aspect of EMDR involves the client moving his/her eyes in a back-and-forth ("saccadic") manner while recalling the event(s). I have done much desensitization and reprocessing over the last several decades on my own and that is why I mention this EMDR here. 1.30.4 In these last five years, 2008 to 2013, I have tried to observe the beginning/initial signs of my defensive or my submissive postures so that I can act more appropriately in what I see as threatening situations. I am slowly learning in these middle years(65-75) of my late adulthood(60-80): (i) to observe the origins of my defensive and submissive responses and (ii) to apply non-defensive and non-submissive action systems like: exploration, social engagement and, perhaps, even play. I hope to learn to recognize my overactive defensive actions sufficiently to prevent and emotional outbursts of anger. I seem to need to learn new reactions and see these resources as replacements for those reactions I once had--and that are not needed any more, not needed as they once were, and which once defined who I was in order to survive. 1.30.4.1 As I write this first draft of the 13th edition of this account in April 2013, I am aware, thanks to my wife, of my interpersonal deficiencies and the need to take defensive or remedial action to prevent inappropriate personal engagement. I am also continuing the processes involved in EMDR referred to above. With the new meds I have been on for one year(4/'12 to 4/'13) my BPD story is taking yet another turn which I describe below. 1.30.4.2 In the last six years(8/07-4/13) what might be called my orienting and defence systems come to occasionally intrude upon and over-ride the functioning of the other systems, severely interfering with love and work, knowledge and play, personal growth and family-social relations. I am still trying to observe and modulate the arousal states which accompany my action systems. As I develop curious, open and non-judgemental exploration of my action systems, they become more robust and immune to take-over by defensive systems. The process is, as they say, a work in progress. The whole thing is complex to understand and difficult to describe in writing. I am trying to make my account as simple as possible for readers. In some ways I feel like a young adult learning systems of interaction for the first time. 1.30.4.3 Nearly three years ago now as I write this update, my wife and I decided to increase my effexor level from 37 & ½ mg to 75 mg due to an outburst of anger and invective the previous day, an outburst that had not occurred with my wife since January 2008 when I had gone right off the effexor medication. This was in August 2010. This is a good example of a meds response in order to modulate my arousal state. I was on this
  • 38. new level of effexor for 20 months by April 2012 when I began yet another meds pkg. My current intention is to stay on this level for as far into the future as I can presently foresee. I thought that at the age of 67 I had finally found a package of meds to stay on for the rest of my life. But this was not to be the case. If some new debilitating illness like Alzheimers comes into my life there will be yet another story. DEALING WITH PTSD 1.27.5 To deal with PTSD it is necessary that I avoid the stimuli associated with the trauma and the increased arousal. If I do not avoid these stimuli, in other words if I subject myself to too much stimuli, the result is: (a) difficulty in falling or staying asleep or (b) sleepiness and the need to go to bed, or (c) anger and hypervigilance. Now, at the age of 69, if I experience a significant degree of annoyance, I try to remove myself from the situation and go to bed. I do not want to experience increased arousal(anger) and the negative social side-affects that go with it. 1.27.5.1 Formal diagnostic criteria for PTSD in the DSM-IV(1994) require that the symptoms last more than one month and cause significant impairment in social, occupational, or other important areas of functioning. Only about 8% of the population develop full PTSD. My PTSD, it seems to me, is partial. Predictor models have consistently found that childhood trauma(associated in my case with my father‘s temper and my mother's illness), chronic adversity(associated with my BPD, employment and interpersonal problems), and familial psycho-social stressors(my marital and family troubles) increase the risk of developing PTSD in adulthood. 1.27.6 One of the treatments I use for PTSD is known as ‗exposure.‘ This involves re- experiencing distressing trauma-related memories and reminders in order to facilitate habituation and successful emotional processing of the trauma memory. Most exposure therapy programs include both confrontation by means of imaginations or creative visualization with/of the traumatic memories and real-life exposure to trauma reminders. This form of therapy is well-supported by clinical evidence. There are other therapies like CBT, cognitive behavioural therapy, or some simple talk therapy as conducted by successful therapists like Dorothy Rowe. The above is a psychotherapeutic approach that aims: (a) to change the patterns of thinking and/or behavior that are responsible for the negative emotions and, in doing so, (b) to change the way a person feels and acts. I do some of this CBT and talk therapy on myself and with my wife. For an extended and useful description of PTSD see Wikipedia and other internet sites. 1.27.7 There are three and possibly four groups of symptoms that are required if a person is to be assigned the diagnosis of PTSD. I have some of the symptoms in each of all four groups. The four groups of symptoms include: 1. recurrent re-experiencing of the trauma in the form of: troublesome memories, recurring nightmares about the trauma and reliving of the trauma. In my case this was recurring nightmares involving mostly classroom teaching, student incivility and control issues as well as various group activities. Traumatic memories are the unassimilated scraps of overwhelming experiences, which need to be integrated with existing mental schemas, and be transformed into narrative language.
  • 39. 2. avoidance to the point of having a phobia of places, people, and experiences that remind the sufferer of the trauma and a general numbing of emotional responsiveness. 3. chronic physical signs of hyperarousal, including sleep problems, irritability, anger, difficulty remembering things,increased tendency to being startled, and hypervigilance. As I say above, though, if I can see my arousal going too high, I try to remove myself from the situation. In the last two years, 4/2011 to 4/2013, I have gone over the edge twice. 4. an emotional numbing which can be seen as a lack of interest in activities that used to be enjoyed, emotional deadness, distancing oneself from people, and/or a sense of a foreshortened future, that is, not believing one will live much longer. At least one re-experiencing symptom, three avoidance/numbing symptoms, two hyperarousal symptoms must be present for at least one month and must cause significant psycho-social distress or functional impairment in order for the diagnosis of PTSD to be assigned to a person. PTSD is considered of chronic duration if it persists for three months or more. Since I manage my symptoms fairly well, I consider my PTSD to be only a partial PTSD, and it is mostly treated. I could probably benefit from some CBT, talk therapy and general psychological counselling but, at 69, am disinclined to venture into that domain. 1.27.8 With PTSD, the traumatic event, although real, took place outside the parameters of ―normal‖ reality, such as causality, sequence, place, and time. The trauma is thus an event that has no beginning, no ending, no before, no during and no after. This absence of categories that define it lends it to a quality of ―otherness,‖ a salience, a timelessness and a ubiquity that puts it outside the range of associatively linked experiences, outside the range of comprehension, of recounting and of mastery. Trauma survivors live not with memories of the past, but with an event that could not and did not proceed through to its completion, has no ending, attained no closure, and therefore, as far as its survivors are concerned, continues into the present and is current in every respect. Although I would not subscribe to all of this description in relation to my own experience, it is sufficiently accurate to include it here to reflect my life with PTSD. DISSOCIATION DISORDER 1.27.9 I would like to add here some comments about dissociation disorders(DD) since some aspects of this disorder seem to me to be relevant to my mental health. The condition of DD becomes a disorder when the walls of dissociation are so profound that the person can't function effectively in the world or be at peace inside themselves. Dissociations are normally unanticipated; they are typically experienced as startling, autonomous intrusions into a person's usual ways of responding or functioning. Due to their unexpected and largely inexplicable nature, they tend to be quite unsettling. This is not a problem I suffer from in a pervasive way, but it does exist in my daily life from time to time. I have no significant amnesia, nor do I have confusing and disconcerting dissociative processes that make me uncomfortable, sometimes painfully so. These are all features of DD. At worse my DD is a very mild case. These walls of dissociation have enabled me to survive some of the various trauma in my
  • 40. life. They have become obstacles as the words from the following pop-song explain: I've built walls, A fortress deep & mighty That none may penetrate. I have no need of friendship; Friendship causes pain. Its laughter and its loving I disdain. I am a rock, I am an island. From ―I Am A Rock‖ by Simon & Garfunkel(1965) DD doesn't have to necessarily be considered a "disorder," and even the DSM-IV notes that "dissociation should not be considered inherently pathological and often does not lead to significant distress, impairment, or help-seeking behavior." (DSM-IV, page 477). This is the case with my DD. DD is more a "condition" or a "state of being" which I have from time to time. It is not necessarily maladaptive or otherwise dysfunctional. Much of what Simon and Garfunkel sing here in the hit-tune ―I Am A Rock‖ resonates strongly with me. But I am not a "total rock." I like friendship, laughter and loving but I have, indeed, built walls and live in a fortress deep and mighty that I do not want penetrated. Perhaps this is partly, or significantly, due to my life after the age of 60 as a writer and author, poet and publisher. TOURETTE SYNDROME 1.28 This is the logical place in this account to mention Tourette syndrome which is relatively common and often mild. But the current estimate is that it affects up to one per cent of the population. Strangely, about 40–70 per cent of Tourettes sufferers appear to have attention 1.12.10 This is the logical place in this account to mention Tourette syndrome which is relatively common and often mild. But the current estimate is that it affects up to one per cent of the population. Strangely, about 40–70 per cent of Tourettes sufferers appear to have attention deficit hyperactivity disorder (ADHD) which I may have had as a pre-schooler. Some 20–60 per cent have obsessive-compulsive disorder (OCD). Although Tourettes is usually worst during adolescence, I do not recall it being manifest in my life at that stage. 1.28.1 On average, in one-third of Tourettes sufferers, the symptoms get worse as they get older. That seems to be the case with me since going on my new medication package. One strange characteristic of Tourettes is that the symptoms wax and wane, with no obvious pattern. The symptoms are unpredictable, being very different from day to day and week to week. It seems that Tourettes is a disorder of the synaptic neurotransmitter chemicals that transmit information. Scanning studies of the brains of Tourettes sufferers show extra activity in those parts of the brain dealing with sensation, movement and language. The brain is fiendishly complex and, for this reason, little is known about the cause of Tourettes. Tourettes is known as a 'spectrum disease'. This means that it has a whole range of symptoms, from short-lived and mild, to chronic and severe. 1.28.2 Samuel Johnson‘s biographer, Boswell, wrote that Dr Johnson had "nervous
  • 41. movements", and would often continually repeat fragments of words, or other sounds. I do this as well. This is the only manifestation of my Tourettes. Like Johnson, I suppress these verbal tics sometimes with a great effort of his will and sometimes with little effort, since they are the cause of embarrassment. The famed neurologist and author, Dr Oliver Sacks, wrote that while "one must not romanticise Tourettes, one may have the rather rare situation of a biological condition becoming an integral part of the identity and of an individual.‖ At the age of 67 Tourettes is now an integral part of my identity but only my wife, and anyone who lives in my home for more than a few days, gets exposed to its features. 1.28.2.1 Identity is, itself, a topic of some importance in this account. A person's identity, says Britain‘s pre-eminent sociologist, is not found in behaviour, nor--important though this is--in the reactions of others, but in the capacity to keep a particular narrative going. I could say much more about the subject of identity, but Giddens‘ words underline how this account I have written about my BPD has the function of ―keeping my narrative going.‖ A lifestyle, an important part of identity, involves a cluster of habits and orientations, and hence has a certain unity---important to a continuing sense of ontological security---that connects options in a more or less ordered pattern. The selection or creation of lifestyles is influenced by group pressures and the visibility of role models, as well as by socioeconomic circumstances. This account of my life experience of BPD places my lifestyle in context. 1.29 This document was originally written in 2001 as an appendix to my memoirs and to assist others in assessing my suitability for: (a) employment, (b) for a disability pension of some kind and/or (c) public or private office in a casual work and/or volunteer capacity. This document is no longer needed for these reasons since I am fully retired from FT, PT and casual/volunteer work and am on two old age pensions. Although this document no longer serves the purpose of helping others to make the evaluations it did a decade ago in 2001 and make their decisions and their personal and organizational assessments of me informed ones; although there is no need for others to assess my capacity or incapacity to take on some task or responsibility, I have kept this original general statement, what was a first edition in 2001 and have extended it to what is now an 12th edition a decade later for other purposes. I tend to update the most recent edition, from the previous year, in the following year as: (i) new knowledge comes to hand, (ii) new experience is added to my BPD history and (iii) as I reflect on 69 years of my experience of BPD. I have included in appendix 5 an article from an online newspaper to place mental health in a wider, populist and, hopefully, helpful context for readers. 1.30 Many do not feel comfortable going to doctors, to psychologists, to clinical psychologists and, more especially, 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, wanting to be more informed and wanting to play more of a role in their own treatments. Perhaps the central issue is trust. People seek help in so many different ways; some try to work things out themselves and there are, of course, various combinations of those who try, those who have given-up and those who go back and forth between the two poles of trying and not trying to sort out their disorder, their psychological problems or whatever. 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. That group includes the sufferers from BPD, depression(D) as well as a range of other illnesses and life battles of a
  • 42. traumatic nature. 1.30.1 Many who suffer from various mental health disorders experience psychological and spiritual crises over many decades. They often become angry at what they see as abuse by the psychiatric profession. They come to mourn all the unnecessary pain and suffering they have experienced and the unnecessary pain and suffering they have caused to others. They often feel they have been overmedicated or been misdiagnosed by their psychiatrists. They come to see their psychiatrists, and even psychiatrists in general as incompetent, as tools of the big pharmaceutical companies and sometimes even as part of a social conspiracy involving social control. As one sufferer put it recently in an email they come to ―firmly plant their flag with the crazies and the mad liberationists, the anti- psychiatry and anti-pharmacology movement, the psychiatric survivors and the human rights activists.‖ I have not ended up in that camp, although from time to time I was on the edges of its increasingly large and diverse company in the wider society. I would like to say a few more things about the world of anti-psychiatry. 1.30.2 The field of anti-psychiatry is a large one. Criticism of the field of psychiatry for issues that have long been recognized within the field and are thus targeted by current research are now easy to access in cyberspace. Here is just a short list of some of the issues: psychiatric diagnoses are based on symptoms rather than pathophysiology, treatments are insufficiently effective, newer medications have provided limited (if any) benefit over older medications, the pharmaceutical industry has had inappropriate relationships with individuals and organizations within the profession; there are problems in access to psychosocial treatments for psychiatric disorders, psychiatrists prescribe medications to treat symptoms rather than correcting known biological abnormalities; the psychiatric understanding of the neurobiology of psychiatric symptoms is limited, and there are not objective biomarkers to guide diagnosis or to match individual patients with particular drugs. Still, it must be emphasized that clinical data provides empirical support for the validity of symptom-based diagnoses. Psychiatry is hardly unique in prescribing medications based on symptoms rather than pathophysiology. Psychiatric pharmacotherapies have limitations that are not very different in relative efficacy from current treatments for many chronic medical disorders(New York Review of Books August 18, 2011) 1.30.3 The underlying science of psychiatry and the reality of the distress and disability of psychiatric patients are two issues that are not emphasized sufficiently in many discussions. These are critical issues because (1) the ability of psychiatry to effectively treat its patients now and in the future depends upon the quality and integrity of its science, and (2) the doubt cast on the seriousness of the distress and impairments of patients seeking psychiatric treatments feeds into the residual ignorance and stigma that continue to be so harmful to patients. Psychiatry is engaged in a challenging battle to understand the most complex aspects of human biology and behavior and to reduce the burden arising from psychiatric disorders. The progress that has been made in the field since I first had to deal with the symptoms of BPD is immense. The enormous and well- documented remaining unmet medical need must also be emphasized. By demeaning the real world challenges faced by psychiatrists and their patients, selectively ignoring scientific progress that challenges critical assertions, and presenting tendentious and highly selected information about the status of psychiatric neuroscience, critics often misuse their authority of status to further stigmatize the field of psychiatry and patients with mental disorders.
  • 43. Many articles on mental health are filled with half-truths that would seem to call for society to abandon psychiatric diagnoses, antidepressant medications, and psychiatric neuroscience. The negative impact of each of these actions on individuals with psychiatric disorders and society is immeasureable. Often such critics provide no alternatives to the status quo or a constructive agenda that might ultimately speed the alleviation of human suffering. Instead, many critics attack the one clear path to better diagnoses and more effective pharmacotherapies, translational neuroscience. By stigmatizing a field progressing toward a scientific foundation and by disparaging treatments that show signs of efficacy, much facile criticism of psychiatry does much harm. Doing harm in this way, in the name of ethics is a form of illusion. 1.30.4 When psychoactive drugs were first introduced in the decades 1950 to 1970, there was a brief period of optimism in the psychiatric profession, but by the 1970s, optimism gave way to a sense of threat. Serious side effects of the drugs were becoming apparent, and an antipsychiatry movement had taken root, as exemplified by the writings of Thomas Szasz and the movie One Flew Over the Cuckoo‘s Nest. There was also growing competition for patients from psychologists and social workers. In addition, psychiatrists were plagued by internal divisions: some embraced the new biological model, some still clung to the Freudian model, and a few saw mental illness as an essentially sane response to an insane world. Go to this link for a further discussion on this topic: http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/ 1.30.5 Often, of course, the anger and sorrow of BPD sufferers is completely justified. Anger tells patients that they have suffered an injustice, that they did not deserve to be mis-diagnosed or over-medicated. As soon as clients come to know in the bottom of their souls that they were and are innocent, that they are the experts in their own experience, that they did not deserve the treatment they received, and that it was wrong, then they may be able to forgive those who made the mistakes and let the whole thing go. Their sorrow tells them that they have lost something of value, and indeed they have. Huge chunks of their lives have been stolen from them or lost or both, and that is sad, very sad. Possessing a philosophy, usually a religious philosophy, that nothing of value is ever truly lost can help. The virtues a person fails to develop, the relationships they broke or destroyed are all waiting for each person in the Kingdom, so goes one line of thought that can be helpful, where the end is finally seen in a new beginning, and that beginning loses whatever sting that had previously existed--if there was any sting. 1.30.6 Our families and our friends see us through the lens of their expectations and that lens is often one that clouds the view and does not help the relationship. But a good therapist and one who is also a Baha‘i tries to see us as God sees us, that is: full of potential and capable of transformation. A good therapist has seen people grow and change. A good therapist has faith in the human spirit. If a person does not have a good therapist, they can at least turn to the Baha‘i Writings in their despair. These Writings can also help us see ourselves through God's eyes. But it is important to choose which Writings one focuses on in order to be inspired by the positive vision rather than overwhelmed by the high standard contained therein. 1.31 This account may help BPD sufferers obtain appropriate treatment and, as a result, dramatically improve their quality of life. I think, too, that this essay of some 95,000 words and 200 A-4 pages(font 14)(160 pages at font 12) is part of: (a) my own small part
  • 44. in reducing the damaging stigma associated with BPD, (b) what might be termed ―my coming out,‖ (c) the small part I am able to play in helping others accept some diagnosis they are given by a professional in the field of mental health and particularly of BPD and/or (d) my way of helping those who have been abused by psychiatry as I have indicated above. 1.31.1 I'll add a few comments here about mental health stigma. The stigma is about people judging people living with a mental illness. If a person has a low self-esteem, then they are feeling bad about themselves. I generally do not have this problem. I have a good self-image, and so it is that other people's negative opinions about me do not have a huge detrimental effect. Their opinions have an affect but it is not incapacitating. Some BPD sufferers do not want to seek a proper mental health diagnosis or get the treatment they need. They decide to hide their mental health problems or even not admit that they have them, thus not receiving the treatment they need and allowing their BPD problems to fester and build up inside them. They often fear: "what would happen if others find out." How would one's life be different if one stopped allowing other people to dilute or poison one's day with their words or opinions? Let today be the day that one stands strong in the truth of one's beauty and journey through one's day without attachment to the validation of others." 1.32 There are so many sub-categories of BPD sufferers and people with mental illness problems generally. Once a person has a firmly established and agreed-on diagnosis, and they are willing to run with that diagnosis, they may find this statement useful. Rather than trying to manage their feelings on their own and rather than rejecting the diagnosis or under-identifying with it, acceptance can be of great help. Acceptance, or compliance as the process is often called, is very difficult for many BPD sufferers. BPD sufferers often who do not accept their illness and for that reason they do not really deal with the issues that are part and parcel of their life as a person. Sometimes their non-compliance is justified. In my case it was not and my non-compliance caused me problems in the decade 1981 to 1991. 1.32.1 Diagnosis is often contingent upon corroborative history obtained from family or friends. Hypomanic or manic symptoms are often egosyntonic, that is, they are not recognized as abnormal by patients. They often affect others rather than patients themselves. Therefore, any suspicion of bipolarity necessitates an independent interview with an objective observer. Whenever feasible, these interviews are best conducted in patients' absence to allow full and frank disclosure. Involvement of family and caregivers is also vital because of the burden that bipolar disorders impose on the support network, especially spouses and children. In my case this was not necessary because I accepted the diagnosis. 1.33 The wider framework of my experience which I outline here is intended to place my BPD in context and should help to 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. Perhaps my statement may help other BPD, and unipolar depression sufferers describe and understand their personal histories. My BPD exists on an affective spectrum, a grouping, of related psychiatric and medical symptoms. These symptoms accompany bipolar, unipolar and schizoaffective disorders at statistically higher rates than normally exist in the general population. These disorders are identified by a
  • 45. common positive response to the same types of pharmacologic treatments. They also "aggregate strongly in families and may therefore share common heritable underlying physiologic anomalies" to use some of the complex language of psychiatry. 1.33.1 The BP II group generally has "suicidal thoughts, guilt feelings, depersonalization and derealization, and atypical features such as hypersomnia and weight gain." I am not a BPII person, alhtough I might have been in my university days. The unipolar depression group experienced higher psychic anxiety and initial insomnia, and assessed themselves significantly higher in terms of slow thinking, feeling the worst, avoiding risks, life dull and dreary, dragging from day to day, and feeling they have no energy. Looking back to my first experience of depression in the autumn of 1963, I would have no trouble seeing that experience as unipolar depression or the beginnings of BPDII. BPD individuals are more likely than those with unipolar depression to display psychotic features during a depressive episode (30 percent vs six percent). This was the case for me in the summer and autumn of 1968. Those with bipolar I had more ECTs (18 percent vs six percent) suggesting more severe depressions, and more suicidal episodes (33 percent vs eight percent). 1.34 This book, as I say, of some 160 A-4 pages(font-12) and more than 95,000 words is written: (a) for doctors and various medical professionals who have dealt with or will come to deal with my disorder and especially for those who are now, at this present time, involved with my treatment should: (i) I decide that they would find such a statement useful or (ii) they request such a statement; (b) for the registered users and guests at internet sites dealing with health in general and mental health in particular: BPD, D and schizo-affective disorder(SAD) among other special mental health illnesses; (c) for some of my relatives, friends and associations over the years with whom I still have contact in these middle years(65-75) of my late adulthood as the years from 60 to 80 are called by some developmental psychologists and to whom it has 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 seven decades. 1.34.1 BPD sufferers also need to be aware of the problem of over-identifying with the illness. There are easy to acquire self-administered checklists to help sufferers differentiate between personality traits, other personality disorders and normal mood swings on the one hand and symptoms of mania or depression on the other. The problem of using BPD as a justification for a range of behaviours or even a lifestyle is very real. I could comment on this at some length. 1.35 This document, this statement, originally written in 2001 for the Australian government‘s now department of Human Services, its Centrelink section which deals with Disability Support Pensions, has been revised many times after further reflection. Now in its tenth edition after feedback from various doctors, friends and internet respondents, as well as after an increase in my own knowledge of the illness as a result of further study, this document is an ongoing and changing, cauldronous and fluctuating entity as my experience of the disorder continues into the evening of my life. I have been on two old age pensions since July 2009, one from Australia and one from Canada. This BPD is still a part of my life.
  • 46. 1.35.1 Readers interested in this story can read it in several instalments/segments at the NAMI site, The National Alliance on Mental Illness>Consumers Section>Posting 18/7/06, among a host of other sites on the internet. This posting provides a much greater and detailed statement. My memoirs, now a 2600 page 5 volume work, place my experience of BPD in a life context. This memoir can be found at eBookMall, in an earlier edition, under the title Pioneering Over Four Epochs or at Baha‘i Library Online in two parts in a truncated form>By author>Price>Go>Scroll down to Parts 1 and 2 of my autobiography entitled Pioneering Over Four Epochs. 1.36 I do not claim to possess a specialized and/or professional expertise in the field of the study and treatment of 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. In northern Tasmania, the region where I live, there is an ARAFMI support program in Launceston less than 50kms away from this town of 7000 where I live. This group in Launceston is for the carers, relatives and friends of the mentally ill. There is also GROW TAS, a support group based on a 12-step self-help program for people suffering anxiety, fear, anger, depression or other symptoms of mental or emotional distress. This group is based in Hobart, a three hour drive from where I live. I do not have any desire or any felt need to discuss my mental health life; I do so on the internet in response mainly to the concerns and interests of others and, initially to post my own story and solicit responses from others. In the last several years I have done this at over 100 relevant internet sites and established a solid presence at many of these sites. 1.36.1 About half of my waking hours in life since my retirement more than a dozen years ago(1999 to 2013) is spent in: social, domestic, and personal hygiene areas; the other half in literary and intellectual domains. Readers of this account can google ―RonPrice‖ followed by one of many words like: poetry, literature, philosophy, psychology, inter alia to give them an idea of my wider writing and life interests. This long piece of writing is but one of the many pieces of my writing these days. The vast majority of my writing and my interests both in and off the internet has nothing to do with BPD. 1.36.2 Sharing experiences through narrative is a central aspect of what has now become a diffuse collection of mental health consumers, survivors and ex-patients. Multitudes now share their experience with the aim of helping others to find their strengths and move toward healing and self-determination. Stories are shared at large and public gatherings, in small peer-support settings, indeed, a host of places by people who have been defined and treated by psychiatry. Such settings provide a means to frame one's own experience with psychiatry, to experience a collective recognition of shared wisdom and learning or tests and injustice, and to identify with the power of heroic and not-so- heroic accounts. A complex relationship exists between behaviour, psychological classification, and psychotherapists and the 90,000 words in this account is a testimony to this complexity. There exists a triadic relationship between classification, classifier, and classified that can have effects not only on the behaviour of those classified with a particular ailment, but also on the description of the ailment itself. 1.36.3 In the half century that I have had symptoms of BPDI I have been part of a world
  • 47. of psychiatry and its often simplistically dichotomised analysis of treatment programs. I have been a survivor of decades of anti-psychiatry literature and a drug-popping consumer society. This dichotomy is not adequate to convey the complex personal reality of my experience as I look back over this half-century: 1962 to 2012. The 'survivor' and 'consumer' identities are not separate entities; they have occurred both simultaneously and serially in my decade-long story. The philosopher, sociologist and analyst Julia Kristeva puts it: ―identity is always in crisis.‖ This is a helpful perspective for the BPD sufferer; it is a view of identity I find helpful. 1.36.4 My use of the word ‗survivor‘ implies, to some extent, that I‘ve been in a concentration camp. There were times when I did feel that way and even now I do feel as if I am a survivor of life‘s battles. ‗Ex-patient‘ is a term I do not want to use now, although I did not mind the term when I had just got out of a mental hospital after several months back in 1968, or after one month in 1980. The term ‗consumer‘ is one I like, and I like it more and more as the years go on. I am a consumer of services. I can get up and I can go and I can get treatment wherever. I don't feel ashamed that I'm a mental health consumer although, given the stigma associated with mental health issues, I am cautious about engaging in discussion. Caution and wisdom, though and I trust, should come to characterize a person‘s verbal art in their old age. 1.37 This long piece of writing, too long for some and perhaps for most, not as sharply focussed on my actual day to day experience as some respondents on the internet have already indicated and not particularly relevant to the experience of others, others with BPD among other disorders, in an illness that has a very wide range of behavioural typicalities. Without going into detail regarding the many typicalities associated with those who suffer from BPD that I have referred to above and without outlining a detailed history of the treatment of BPD in the medical and psychiatric fields, all of which can now be easily googled on the world wide web, allow me to briefly describe two creative people who suffered from BPD, the famous composers Tchaikovsky and Robert Schumann. I could easily have chosen dozens of others whose lives and whose experiences of BPD are now well-documented. See: David Brown, Tchaikovsky: The Man and His Music, Pegasus Books, New York, 2007 for the life-story. 1.37.1 It doesn‘t take much listening to Tchaikovsky music to appreciate that he was a very emotional man, a man whose passions often got the best of him as they often have got the best of me. He suffered from BPD with its highs and lows following upon one another with bewildering rapidity. He had many episodes of depression and many panic attacks which often resulted in flight, in tearful reactions to events, in impulses to overwhelming generosity and kindness and outbursts of angry temper. The result of all this emotional stress and struggle was that in 1890, when Tchaikovsky was in America, some commentators took him to be in his sixties, ten years older than his actual age and this had the effect of depressing him even further. 1.37.2 Typically for Schumann, when he was in a manic state he would compose feverishly, but when he fell into a depressive state, he was virtually paralysed. It makes me wonder: What if Schumann had prozac or lithium? Would his creativity have been helped or hampered by these modern, so-called wonder drugs? Would his autobiographical Second Symphony tell a different story? As it stands, I hear the music pulsing with Schumann's journey from abject depression to triumph and joy. It's a parallel to Beethoven's own personal journey in his Symphony No. 5.
  • 48. 1.38 After some 68 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 cannot do so because I still suffer, even after 68 years, with problems that are part of this disorder‘s long history and its current manifestation in my life. I have also become more conscious, as I have come out as it is said colloquially, of how this lengthy personal statement has come to be of great help to many, especially at the more than 100 mental health sites on the internet where I place all or parts of this document. Major affective disorders continue to be the leading causes of psychiatric disability and the need to develop safe, effective, and efficient long-term treatments for these disorders is of extreme importance not only to professionals but to the millions of sufferers. People like myself with life experience of BPD have stories that can be of use to other sufferers. That is at the core of my motivation for all the internet posting I do at mental health sites related to BPD. 1.39 Readers who are busy and not inclined to read a long statement like this are advised to skip, to scroll-down to section 10.3.9 below and some of the sections following after 10.3.9 to avoid reading much of the history and much of this statement that is not relevant to their needs. They can then: (a) make some practical assessment of this account, an assessment relevant to their present and personal needs; (b) obtain a shorthand account of whatever information in this document is relevant to their particular situation; (c) assess my suitability to undertake: (1) some form of employment: FT, PT, casual or volunteer; (2) some task that they think I could take on or some social or leisure activity in which I could engage with profit to others; (d) assess whether they themselves can go onto a pension of some kind and, finally, (e) understand my background of BPD more fully and so contextualize my life in order that they might understand me better. 1.40 Data from the United States on the lifetime prevalence of BPD--and mine has been a lifetime of BPD--indicate a rate of 1 percent for Bipolar I, 0.5 to 1 percent for Bipolar II or cyclothymia and between 2 and 5 percent for sub-threshold cases meeting some but not all criteria for BPD. There are many statistics in relation to BPD which I do not list here. 1.41 I could make a few general comments about the increasingly close relationship between: (a) the pharmaceutical industry and the American Psychiatric Association (APA), (b) about a sub-field of philosophy and sociology known as hermeneutic phenomenology, (c) anti-psychiatric and (d) literary perspectives. But such comments would be largely tangential to this account and so I leave such themes outside my statement here. 1.42 My experience, my distress, has been given the name BPD. This disorder exists within a socially accessible grid of intelligibility and has been provided with a solution. Seeking out cause, prognosis, and cure within my physical anatomy, my genes and chemistry through tests and palpable signs, the bio-medical discourse of psychiatry maintains the modernist, positivist view that scientific methods are objective and can ultimately lead to a universalizable truth. Critics of this particular framing of distress are typically placed in three camps: anti-psychiatry, critical psychiatry, and increasingly, post-psychiatry.
  • 49. 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 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. ―Feeding‖ ordinary, normally transient feelings of sadness with sad or negative movies, books, music, and conversations with negative people was a difficult habit to overcome. Indeed I still have to deal with this challenging aspect of life‘s battle after decades. 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 MD in May 1980. I was treated by a psychiatrist in Launceston Tasmania while in the psychiatric wing of a general hospital. I had often been on the fringe of BPD, 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 had not been approved by the FDA in the USA until 1970 and only in 1974 as a preventive treatment for manic-depressive illness(MD). 2.3 Lithium was the first really successful mood stabilizer used by doctors beginning in the 1970s to treat MD. In the 1980s and 1990s MD came to be called BPD. Lithium cushioned the effects of extreme depression, hypomania and mania. It prevented their effects from striking at my life during the years 5/'80 to 5/'07. The perils of BPD existed, as I look back more than 30 years after my last manic episode, in what I did in the midst of: (a) those two manic episodes to deal with: decreased need for sleep, decreased self- control, irritability and risk-taking behaviours in 1968 and 1980, (b) the mixed highs and lows from 1963 to 1967 and 1978 to 1980; (c) schizo-affective or psychotic states in 1968 and 1979-80 episodes; and (d) depression periods with their moroseness, extreme melancholia and suicidal wishes in 1963, 1964, 1968 and 1978. 2.4 My history up 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 from the norm, from my norm, is only part of my story. But it is a crucial part. Everyone has their story; 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.
  • 50. 2.5 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 2012 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. 2.6 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, more than four decades ago, (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, and, finally, (d) several writers like Virginia Woolf and Sylvia Plath who wrote about their BPD in addition to the many now in cyberspace who tell their stories. 2.7 Comments on My Ante-Natal, Neo-Natal, Childhood and Adolescence Life: BPD--Phase One-Part One: 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 them 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), (b) Oppositional Defiant Disorder, or conduct disorder, but it is difficult to disentangle those features from those of BPD. I certainly exhibited episodes of hyperactivity-impulsivity or just impulsivity, but I cannot find any detailed information about these early years since everyone who knew me then is now dead, not contactable or not someone with whom I want to raise these issues. 2.7.1.1 Research on childhood/paediatric and adolescent/youth BPD is taking place in five major areas: clinical phenomenology, neuropsychology, neuroimaging, chronobiology, and genetic studies. See also: D. Healy cited in ―New Research Findings,‖ internet blogspot, 22/8/08. But I do not deal with these areas in any depth. Functional neuroimaging is a promising tool for the investigation of the brain changes induced by psychotherapy. So far, only few studies have used it to assess the effects of
  • 51. CBT in OCD and phobia, and of CBT in depression. 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 behaviour associated with depression, anxiety, fear, anger and other symptoms of mental distress like obsessive-compulsive neurosis. Markers are essential to understanding the anatomical basis of mental disorders, diagnosing them objectively, and following their responses in daily life situations. 2.7.2.1 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. In the mid-1990s, two highly influential psychiatrists at the Massachusetts General Hospital proposed that many children with ADHD really had BPD that could sometimes be diagnosed as early as infancy. They proposed that the manic episodes characteristic of BPD in adults might be manifested in children as irritability. That gave rise to a flood of diagnoses of juvenile BPD. Eventually this created something of a backlash, and the DSM-V(2013) now proposes partly to replace the diagnosis with a brand-new one, called ―temper dysregulation disorder with dysphoria,‖ or TDD, which one psychiatrist calls ―a new monster.‖ 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, as I say above in section 2.7.2 and in the footnote #14, is difficult. 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 pathogenesis, 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, 2.7.4.1 and 2.7.4.2. 2.7.4 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. 2.7.4.1 Functional neuroimaging studies of euthymic/normal 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
  • 52. existence of neurobiological trait abnormalities in BPD at various scales of investigation. The 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 I try to avoid the complex language found in the above two sections not only because readers rarely understand them but also this complex terminology is also well over my head. We all have limits in trying to understand things. This is true in the complex mental health field as well as in many other domains of modern life—no matter how hard we try. It is important for BPD sufferers to recognize the limits of their own rational faculty, the endowments conferred by birth and by socialization in their intellectual domain. Drugs used to treat affective disorders exert their effects largely through their actions on various neurotransmitter systems. Neurotransmitters are important regulators of neural development. Beyond this, beyond these last two sentences, readers do not need to know the complex physiological and neurobiological systems that underpin BPD. 2.7.5.1 Patients often view psychiatrists as wizards of neurotransmitters, who can choose just the right medication for whatever chemical imbalance is at play. This exaggerated conception of the capabilities has been encouraged by drug companies, by psychiatrists themselves, and by the patients‘ understandable hopes for cures. Psychiatrists target discrete symptoms with treatments, and other drugs are piled on top to treat side effects. 2.7.6 Theseus used a ball of thread as he entered the labyrinth of the Minotaur. He fastened this thread to the door and let it trail behind him as he went in. After killing the Minotaur in the remotest section of the labyrinth, he managed to make his way out again by pulling himself along the thread. I used this legend to develop this technique of psychoanalysis, disclosing key events of early life as the origin or cause of the actual problems of a patient. It seems worthwhile to use the thread of Theseus to unmask the biological and genetic mechanism leading to an enhanced susceptibility to both environmental and mental maladaptation to our modern environment. Additionally, the principles of psychoanalysis may help unearth early traumas, fear and anxieties that lead to stress and comfort eating. The combination of repressed angst caused by early life trauma, chronic psychological stress, depressive features, paralyzing lack of physical activity and eating that is dissociated from actual caloric needs keeps large segments of our society from controlling their weight. Lasting solutions to obesity must address the interface of reality, repressed fears and unconscious conflicts that determine the specific pathways of the search for pleasure. Testing of these hypotheses would be a most appropriate birthday present for me. 2.7.7 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, hypersexuality and (b) a far too intense activity threshold what is now called hyperactivity or hypomania. As I write about this, I feel a tendency to overstate my case. 2.7.6.1 It should be emphasized in this context, though, that hypomania is now
  • 53. 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 a maniacal posture or of mania in psychiatric terms. The wider culture in the West is increasingly characterized by the loosening of the boundaries of restraint and millions who, in generations gone before controlled their instinctual and impulsive, their spontaneous and natural, urges are now giving way to them. My more impulsive BPD nature could now be considered normative in some ways and certainly not a sign of a disorder: such are the changes in societal values and attitudes, behaviour and norms and their effect on the way a person like myself might come to view the manifestations of their BPD both now and earlier in my life.(for a useful discussion of impulsivity go to:http://en.wikipedia.org/wiki/Impulsivity 2.7.6.2 The aetiology and earlier manifestations of BPD in ante-natal, post-natal, childhood and adolescent periods I have yet to describe and I do not deal with them in this essay expect en passant. BPD occurs in childbearing women and the onset of BPD symptoms may occur at the ante-natal stage, in utero, during pregnancy or after the birth in the neo-natal stage of childhood as it is called. This may have been the case with my mother; it may have been another episode of BPD, further episodes to the ones she had had prior to her pregnancy in 1943-4. Her symptoms after birth, in 1944, may have been similar in some ways to those that occurred with her BPD earlier in her life. The book The Bipolar Child by D & J. Papolos(Random House, NY, 2000) brings out the extent of the current mania of interest in BPD in children. 2.7.7 I recall at the age of 12/13, at the onset of puberty, exhibiting inappropriate or precocious sexual behaviour. The particular manifestation of this inappropriate behaviour involved an episode of groping and an attempt to kiss a girl who did not want to be kissed. I backed off quickly when I saw she was uncomfortable, but the incident is imprinted on my memory to this day. 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 an old and uninhabited house in which the charge was dropped and (c) an 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. The sexual manifestation of this shift was kept in control throughout my teens perhaps through my absorption in sport, school, employment and various leisure activities. Society value shifts in the 1960s accentuated these 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 is now in my memory bank and in the greater appreciation that I now have for my mother than ever before. Neither she nor I nor my doctors knew that I had BPD since it was not diagnosed until I was 35 in 1980. 2.7.7.1 I am now going to make a few more comments about the sexual aspect of BPD as it has been manifested in my life. I have never had a problem with compulsive sexual behavior defined as ―spending inordinate amounts of time in sexual-related activity to the point that a person neglects important social, occupational or recreational activities in favour of sexual behavior." My personal sexuality has been a subject both I and my psychiatrists have avoided since I first met with a psychiatrist in the summer of 1968— over 40 years ago. My sexual activity has never been a subject which sufficiently concerned me to bring it up when talking about medications, sleeping problems and other issues associated with my BPD experience. The literature on BPD and sexuality
  • 54. points to the complaint of some patients that doctors rarely want to hear about their sexual problems. I have rarely wanted to talk about my psycho-sexual problems with a psychiatrist, rather, I have preferred to work them out in the context of my marital relationship. Since beginning to take a medication for my prostate problem in March 2013, my libido, the intensity of my sexual urges has declined markedly to a position of near, of relative non-existence. 2.7.7.2 The term addiction is imprecise and laden with value judgments, but it captures the essence of a very real phenomenon. Psychologists and psychiatrists formally define substance dependence as a disorder characterized by criteria that include: (a) spending a great deal of time using the substance; (b) using it more often than one intends; (c) thinking about reducing use or making repeated unsuccessful efforts to reduce use; (d) giving up important social, family or occupational activities to use it; and (e) reporting withdrawal symptoms when one stops using it. All these criteria can apply to people who are addicted to sex or watch a lot of television. That does not mean that sex or watching television, per se, are a form of addiction or even problematic. Both sex and television can teach and amuse; they can bring us to aesthetic and sensory heights; they can provide much needed, even if socialized, distraction and escape. The difficulty arises, the addiction exists when people: (a) strongly sense that they ought not to engage in the activity as much as they do and (b) find themselves strangely unable to reduce the activity(i.e. participating/ viewing. Some knowledge of how TV and/or sex exerts the pull that they do may help active participants/viewers gain better control over their lives. 2.7.7.3 Compulsive sexual behavior--sometimes called hypersexuality, nymphomania or sexual addiction--involves a normally enjoyable sexual experience that becomes an obsession. Such an obsession is listed as one of the primary symptoms of BPD in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). Many psychiatrists refer to the psycho-sexual domain of interpersonal life almost as an afterthought—if at all—when forming a diagnosis. Though hypersexuality may present itself as just one aspect in a constellation of problems, it is often the most destructive and challenging part of BPD. My obsession with sexuality and the erotic, if indeed I have had an obsession technically, has been kept, for the most part, under control as I look back at perhaps 60 years of its manifestation in my life. This is not to say that the psycho-sexual aspect of my life has not been a problem. Pleasure-seeking behavior and instinctual elements dictate fundamental aspects of our daily life however difficult this may be to accept. Orgasm releases endorphins, the basis of the feeling of pleasure; sexual activity improves cardiovascular function. As I say above, since beginning to take a medication for my prostate problem in March 2013, my libido, the intensity of my sexual urges has declined markedly to a position of near, of relative non-existence. 2.7.7.4 Compulsive sexual activity troubles families of young children suffering from this symptom known as child and juvenile hypersexuality; it ruins marriages and can generate life-threatening health problems. One study found that hypersexuality appears to play a larger role in women‘s lives than in men‘s. Women are more sexually provocative, seductive and tend to take more risks than their male counterparts. Impulsive new relationships and impulsive sex frequently involves risk-taking behavior
  • 55. to both the self and others. Sexual intensity is very much increased during hypomania. It is often seen as the most important and enjoyable part of BPD. Another study reported that flirtatious and sexual behavior was a common symptom in 30 per cent of young, prepubescent children with hypomania and in 60 per cent of the adolescents. Their vulnerability is attributable to a ―disinhibition‖ of social restraints during hypomanic periods. In other words, they are unable to act with an eye toward future consequences of their behavior. Sex is used for soothing the anxiety of BPD. Finding the right combination of medications to control hypomania is an essential step toward keeping hypersexuality from becoming destructive. I mention all of the above as a backdrop to the problem I have had with the intensity of sexual desire in my life. (See: ―Compulsive Sexual Addiction,‖ Mayo Foundation for Medical Education and Research: 1998-2010, 18 September 2009 at About.com for an expansion on some of the information I have drawn-on here) 2.7.7.5 Impulsiveness and risk-taking in general and in relation to sexual desire in particular has been a problem for me all my life. Keeping control of my sexual inclinations has been a battle. I hope that the above Sections 2.7.7 and 2.7.7.1 to 2.7.7.4 above help to place my battle in a helpful, and more importantly, an accurate context. As I point out above I have never had a problem with compulsive sexual behavior if I define it, using the Mayo clinic‘s definition cited above, ―as spending inordinate amounts of time in sexual-related activity to the point that a person neglects important social, occupational or recreational activities in favour of sexual behavior.‖ I have been far from free, though, of compulsive sexual activity. I can point to examples of it in my life beginning with the one cited above in section 2.7.7, the two episodes of pre-marital sex in 1967 and again in 1974/5 to my present need to exercise self-control even in the evening of my life now at the age of 69. Compared to the lack of control, the loosening of former inhibitions, the whole freeing- up of libidinous urges in the wider society in the last 30 to 50 years, my story is a mild one, some would consider my story to be a normal battle of self-control that males have had for millennia. I could use such a view as part of a philosophy or technique for neutralizing any guilt. Such a view also helps me avoid accepting a deviant self-image and justify my inability to achieve the high standard of chastity. 2.7.7.5.1 There are different aspects of impulsive behavior and various mechanisms involved in individual predisposition to impulsivity, risk-taking and their related psychopathologies and they are only partly understood by the medical profession and psychiatry in particular. My vulnerability to impulsivity, it seems to me, is associated with or attributable to, a certain disinhibition of restraint. This disinhibition, this impulsivity, is due to a periodic craving for the high associated with sexual release, what some writers call: the spasm and the consequent release of endorphins, as I mentioned above. Impulsive new relationships and impulsive sex have frequently involved risk- taking behavior in my life with negative consequences, consequences that have had a significant role in determining my life‘s trajectory. Of course, the word 'frequently' is a subjective term and what is frequent for one is relative abstinence for another. This tendency to the impulsive, though, is also related to anger and control issues which I discuss elsewhere in this account. This tendency may be due to, so some studies in molecular psychiatry indicate, cellular factors which play a prominent role in the brain
  • 56. control of stress, the most important vulnerability factor in mood disorders, causing behavioural, cognitive, and neuroanatomical problems. 2.7.7.5.2 Celibacy outside of marriage and abstaining from sexual activity before marriage is probably a greater test for almost everyone who aims to live up to that standard for religious, social or simply personal moral reasons. But tests are one of the main aspects of what human life is all about. It doesn't matter what a person's sexual orientation, preferences and inclinations might be or what urges they might feel. Life is not anarchy and giving way to impulse in many areas other than the sexual has certainly resulted in a degree of anarchy in my personal life. Again, though, anarchy for one is not anarchy for another. Most of my life has not been anarchy; I have also had a directed path with a purpose. If I did not have the path I chose in my late teens, a path with a religious focus and standards of abstention from sexual activity outside and before my marriage, my life would have been much more than the anarchous mix that it has been. My religion, the Baha‘i Faith, has been indispensable here in this critical area of human behaviour which, in the end, determines so much that constitutes the nature and detail of one‘s journey in life. Those wanting to read my five volume memoirs, my 2600 page autobiography, can follow-up on this topic of risk-taking, a behaviour that has played a significant part in my life. 2.7.7.6 Risk-taking behavior in general and impulsivity in relationships in particular are problems that people with BPD have to deal with all their lives and some BPD sufferers- --in addition to millions who do not have mental health issues---deal with these problems more than others. Since it is neither possible nor desirable to go into chapter-and-verse on the literally thousands of social situations in my life where this risk-taking behaviour has manifested itself, some to my advantage and some to my disadvantage, some associated with sex, some with anger and still others with many other aspects of behaviour and related emotions, I will try and make a brief overall-summary statement here. 2.7.7.6.1 Looking back over seven decades, the years 1948 to 2013, from early childhood to puberty and on to the present, I can site several categories of risk-taking activity in relationships and situations that significantly affected my life-trajectory, my life-narrative. I jumped too quickly into relationships with the opposite sex and this was true with respect to both my marriages; I changed jobs with a frequency which described on a CV or resume is both colourful and impressive on the one hand but an indication of instability and risk-taking on the other; I was often insensitive to the reactions of others causing others to be embarrassed and negative feedback to come my way; I was a highly successful student over an 18 year period and a highly successful teacher over a 32 year period. But I know that, of the thousands of students I had during these years, that there were many who had a negative reaction to both my style of teaching and my personality in general. This is very common for all teachers---with or without BPD. Aspects of my behaviour in this summary statement can and do apply to millions of non-BPD sufferers. I am also aware that I should not/cannot blame all of my negative behaviour on BPD or, indeed, on socialization. But risk-taking behaviour and the need for high levels of stimulation are two syndromes that need to be given a mention in this lengthy narrative. 2.7.8 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
  • 57. and my in utero, ante-natal, life as I intimated above, for possible origins and manifestations of BPD. The relationship with my mother, my disinhibitions or lack of emotional control in relation to sex and anger, 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. 2.7.8.1 In this lengthy account I also do not allude to my periods of grief on: the death of my mother, the separation from my first wife and several experiences in the Bahá'í communities where I have lived over the last fifty years. The grief and anxieties, the general tests and difficulties, that have been part of my life are not part of this story, a story which focuses on BPD and my mental health and not other aspects of my life associated as many of them are with my disability. Susan Inman‘s book After Her Brain Broke–Helping My Daughter Recover Her Sanity, Bridgeross Communications, 2010-- reminded me of the fierce emotions I had against my mother when hospitalized in 1968 but my treatment, unlike that daughter‘s, only took months and not years and I do not document/describe that treatment here. 2.7.9 I don‘t think I will ever know enough about my early childhood, that is the years before the age of 5, to assess whether my short periods of behavioural disorientation were examples of: (a) a mild-mania, or hypomania as it is called, (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. It is becoming, some say, a simple catchall applied to explosive and aggressive children and other kinds of idiosyncratic behaviour. State of the art brain imaging is now studying individual differences in brain structure and functioning and the genetic predisposition is a focus in this area. 2.7.9.1 Others say that many behavioural abnormalities are finally being recognized as part of a single disorder or recognized as existing on a single continuum. There is now a growing debate over the accuracy of many diagnostic classifications. This might seem to be purely academic except for the effect it has on treatment protocols. Estimates are that on average it takes 7 1/2 years before a BPD diagnosis is made. Improperly diagnosed BPD and delayed diagnosis are facts that BPD sufferers and those with D should be aware of especially if they are in their teens and twenties. 2.7.10 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 my puberty in 1956/7, the opportunities to go over the top and to let physical/sexual temptations assume too great an importance have increased. As I emphasized above, though, since beginning to take a medication for my prostate problem my libidinous urges had just about disappeared. My mother took a liberal and understanding 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
  • 58. life‘s tests. It would, though, be incorrect to say that I have been permissive sexually. 2.7.11 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 emotional and behavioural intensities) at puberty and then in adolescence as possibly having a link with the BPD which was eventually diagnosed when I was 35 years old. It was not until I was 19 in 1963 that any characteristics of BPD, in retrospect, became quite clearly apparent, pathological and, as I say 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,‘ a term used by the founder of Christian existentialism Soren Kierkegaard. He called this a despair at willing to be oneself. I felt despair but not in the sense that Kierkegaard used the term. 2.7.11.1 I had never experienced such an intensely low mood. The word despair is a more appropriate one. 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. 2.7.11.2 The psychiatric medications which those who are mentally-ill receive increase the likelihood of weight gain, diabetes and cardiovascular disease. Mental health professionals have discovered that physical disability and early death add to the burden of mental illness for those affected and their families. The burden does not stop there since the health care system, already groaning from the weight of the consequences of various habit disorders, shoulders the extraordinary health costs of this high need population. 2.7.11.3 As I say elsewhere in this statement, it is not my intention to dwell on my sexual life since, like my job, my family, my relationships and my religion, I regard them all as tangential to the focus on the BPD itself but I cannot eliminate reference to them on occasion since they are in varying degrees relevant to this narrative. 2.7.12 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 in the West until about 1900. The desire to die at that time in 1963 was overwhelming. But I did not talk about it to anyone except perhaps my mother, although I honestly cannot 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. By May 1964 a mild euphoric state had arrived. I worked for the Bell Telephone Co. in May-June 1964 and lost my job due to being too talkative, laughing inappropriately and being, in summary, too-high as I look back as best I can from a perspective of 45 years after the event. 2.7.13 These behaviours, this depression and this euphoria, 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
  • 59. 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 that exists in between BPD 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 1968 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 some two years after I was released from the large psychiatric hospital outside Toronto in the town of Whitby. This account could give a detailed story of the five months of institutionalized care: the ECTs, the medications, the occupational therapy, etc. At the age of 19 during the first manifestations of intense depression, though, I was given lots of advice from religious to common-sensical: diet, exercise, prayer, vitamins, interesting leisure distractions and interests like horse-riding, watching TV, music, et cetera. This sort of advice, or at least specific areas of advice like diet and exercise, continued to be given to me throughout my life. Sometimes I followed the advice and it was to my advantage and sometimes it was not to my advantage. 2.7.13.1 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. Looking back from the time I am revising this statement just before my 68th birthday, I now see these years from 1963 to 1968 as evidence of BPDI. My experience over the years from 1969 to 1977 ws clearly sub-threshold. but from December 1977 to June 1980 I had another full- blown hypomanic attack, the 2nd in my life. This 30 month period, which ended in my being stabilized on lithium, had a different emotional story, a different set of ups-and- downs, than the story of the 60 month period 1963-68. Each period exhibited quite separate and distinct tendencies and patterns. I discuss the ten years, 1969 to 1978, of relative normality, briefly below in this now lengthy account. 2.7.13.2 University or college in some ways radically restricted my ability to panic. In the existential sense, college offered an expansion of life‘s possibilities, but in the flesh- and-bone sense, it narrowed them. College threw me into cramped living quarters with people I had never met but whom I had no choice not only to endure but also to shower with, brush my teeth alongside and defecate not three feet from. After close to two decades of cohabiting exclusively with parents and dealing for the most part with my friends, this shift caused a fair amount of psychological friction. This is particularly true because it is something of an imperative to present oneself as poised and confident, even if one is in fact bilious, angst-ridden and actively decompensating. After four months with such a situation living with three other boys, I could not endure it and went back home in a state of mild depression. By my 3rd or 4th week at university, round-the-clock anxiety and the addled half-sleep that comes with it had eaten so thoroughly into my defenses that a deep depression has set in, a depression that I hid from everyone as best I could. At home when I was anxious I could count on two places in which I was free to freak out as extravagantly as I wanted:
  • 60. my bedroom and my bathroom. But in the halls of academia it was almost impossible to find the solitude a real anxiety attack demands. Kierkegaard once claimed that anxiety is our ―best teacher.‖ He was correct, to a point. By underscoring the tensions in our minds and goading us to action, anxiety does indeed teach us. But as the chronic sufferer discovers, and I was from time to time down the long decades, the best teacher is not anxiety itself but the ceaseless, lifelong effort to think clearly and act well in spite of it. In the case of dealing with BPD that thinking needs to be sharply focussed on getting the best cure to one's emotional dilemma. 2.7.13.3 One aspect of the five months in that immense psychiatric facility in Whitby Ontario in 1968 that I would like to comment on is the short visits with my psychiatrists during ―their rounds.‖ It was like a visit with God and it was always impossible to really say much. I remember spending much of my time trying to get appointments for long sessions. I've had experience, since then and with psychiatrists elsewhere, in hospital psychiatric clinics/wards and the private practice facilities of psychiatrists who only see patients for short appointments usually of an hour or less. But in Whitby the sessions were usually for a minute or two at best. I never felt like the doctors or staff got to really know me; therefore, I didn't trust their judgment. I now see my psychiatrist, more than 40 years later, for short medication-management-type appointments. and a discussion of related issues, usually for periods of time from 20 minutes to an hour. It's not expensive even when I require more frequent visits due to the Australian health care system. I saw the same psychiatrist, a Dr. Ratcliffe, from 2001 to 2012. In April 2012 I began to see a new psychiatrist. 2.7.13.4 I want to make a few remarks here about deinstitutionalisation(see Wikipedia for an excellent overview of this subject) a process of replacing long-stay psychiatric hospitals with less isolated community mental health services for those diagnosed with mental disorder or developmental disability. I mention this because after 1968 I was never institutionalized again, although I did have one month in the psychiatric wing of a general hospital in 1980. Deinstitutionalisation can have two definitions. The first definition focuses on reducing the population size of mental institutions. This can be accomplished by releasing individuals from institutions, shortening the length of stays, and reducing both admissions and readmission. The second definition refers to removing institutional processes from mental hospitals that may create dependency, hopelessness, learned helplessness, and other maladaptive behaviours. In many cases, the mass deinstitutionalisation of the mentally ill in the Western world from the 1960s onwards has translated into policies of "community release". Individuals who previously would have been in mental institutions are no longer supervised by health care workers. Many are left to their own devices in regards to maintaining their personal medication regimens. My experience of BPD after 1968 was in the context of this massive deinstitutionalization and working out my own treatment with the help of professionals of my choice. 2.8.1 In BPD episodes of depression occur alternately with manic or hypomanic episodes during which the mood becomes euphoric and labile, the capacity for deriving pleasure increases, behaviours aimed at deriving pleasure increase, energy and psychomotor activity, libido and self-esteem become elevated. Thus, the same domains are implicated in depression and mania, although the characteristic disturbance in emotional behavior within these syndromes appears opposite with respect to emotional valance. Thus the
  • 61. clinical manifestations of mood disorders would appear to implicate the cognitive, emotional and visceral functions. 2.8.2 Mania, mild mania or hypomania are all symptoms of BPDI and they each have their origins in extra-neurotransmitter brain cells. These cells, due to neurochemical over-stimulation, begin to fire all at once for a sustained duration of time. This is a very disquieting symptom involving rapid and profuse synaptic activity that is quite tiring and can interfere with concentration and focus. This, in turn, can cause rapid, erratic thought patterns and ideas. People with mania and/or hypomania often remain awake for days without normal sleeping intervals. The longest period of time I was awake was two or, perhaps, three days in May 1968. The experience became progressively more painful after 24 hours of no sleep. I had no mood-stabilizing medication at the time to slow the synaptic activity down. I do not recall any symptoms of mania or hypomania in my late childhood or adolescent life. There were some periods of hypomania in the years 1963 to 1966 but not as intense as what I experienced in May 1968. If I had any mania in early childhood, I have no memory of such experience. 2.8.3 The boundaries between normality and abnormality, health and pathology are often blurred and indistinct. In addition these boundaries shift from person to person, doctor to doctor and decade to decade making one‘s understanding of the problem more complex and more difficult to deal with on the one hand and, paradoxically, more simple and easy to deal with on the other. Within those five years, 1963 to 1967 though, the permutations and combinations of emotional variation were enough to bring 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. There were periods, though, in those several years of my post-secondary school education in which I could function normally and my moods seemed to level out so to speak. 2.8.4 Although the pharmaceuticalization of the post WW2 modern world had begun in earnest by the 1960s, it had not taken off that earnestly as medical and psychiatric 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. 2.8.5 Sometimes I returned to incapacitating symptoms; sometimes I simply exhibited impetuosity or lack of emotional restraint; at other times my moods were expansive, euphoric, hypomanic. 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 often bizarre and chaotic nature of the experience. Given, too, a coextensive- coexisting general context 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. 2.8.6 In the years December 1968 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
  • 62. or even suggest medical intervention. During these years I experienced my first successes professionally and my energy levels seemed to increase slowly from 1969 to 1972 to pursue my jobs in the teaching world and in the Baha‘i communities. In some ways this period 1972 to 1978 was a manic period with a tremendous outpouring of activity. Then in December 1977 it all crashed down into depression and the kinds of symptoms I had had in 1967 that took me into four psychiatric hospitals. 2.8.6.1 The 30 month period from 12/'77 to 5/'80, as I say above, was my next major episode which contained an episode of mania in May 1980. It also contained periods of depression exaccerbated by the stelazine treatment. That first episode which included mania 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? 2.8.6.2 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 lost only fifteen months of employment due to hospitalization. They were in the periods: 6/68 to 12/68 and 5/80 to 12/80, although I experienced much more time of varying degrees of decreased functioning in my various places of work. 2.8.6.3 Taking an early retirement at the age of 55 and going on a disability support pension at 57 until I was 65 could be said to add another ten years onto that one year of unemployment due to BPD. If I wanted to make a fully comprehensive statement of the effects of BPD on the total years of my unemployment, that would come to eleven years. 2.9 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 some 45 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. 2.9.1 In the episode 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 December 1977 to May 1980, 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. 2.9.2 Paranoia is a disturbed thought process characterized by excessive anxiety, fear and/or anger, often to the point of irrationality and delusion. When it is combined with depression the emotional state of the individual--in this case me—it is a type of terror. 2.10.1 The psychologist Abraham Maslow has written about what he called the
  • 63. Desolation or Nadir Experience. I will comment on that experience here since I have had several such experiences in life. It is the meaning of the experience, the process of reaching out to hidden meaning, that is important to me now. One aim in narrating the experience is to end the narrative knowing more about myself and reality based on the experience than I did when I began. I try to take an affirmative stance toward those nadir experiences not one of dismissal or denial. This affirmative stance tends to potentiate the meaning of my desolation experiences, whereas the denial tends to depotentiate the experiences. 2.10.2 On the other hand, what Maslow describes as ‗peak- experiences,‘ what were previously the "heights" or "peaks" of my experience have become in these years of my late adulthood every day experiences. My day-to-day experience I would describe as very serene since being stabilized on my current meds package several years ago. This serenity extends over most of the day until after midnight when I am getting ready for bed. Maslow refers to this as a plateau experience in which one perceives life "under the aspect of eternity‖ and activity becomes mythic, poetic, and symbolic about ordinary things. One lives, Maslow, writes, in a world of miracles all the time. Perhaps this overstates my experience of this plateau; it is due to my medication cocktail but it is a genuine plateau of serenity over long periods of time broken-up by sleep and the inevitable contingencies of quotidian and domestic reality. 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 twelve editions over twelve years to get some sense of coherence, some sense of continuity, into what some biographers and auto-biographers sometimes call a ‗chaos narrative.‘ Many readers at internet sites only want short responses to their questions and I try, when possible, to cut- and-paste material from this long account that is relevant to their questions and short in length. 2.11 From My First Episode of MD in 1963: To My First Institutionalized Care in 1968: 2.11.1 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. In 1970, while living in Picton, I attended an interview with a
  • 64. psychiatrist in Kingston Ontario who informed me that the diagnosis of my condition which he had received by letter from the Whitby Psychiatric Hospital was: that I had had ―a mild schizo-affective disorder.‖ But I do not recall receiving any statement while in Whitby. 2.11.2 While in these four psychiatric facilities I received many treatments. It is not my intention to go into detail regarding these treatments after the passing now of more than 40 years. I remember, though, being on a first generation antipsychotic medication: chlorpromazine(largactyl), a phenothiazine, for some time and ten years later, in 1978, I was prescribed another phenothiazine alled trifluoperazine (stelazine). In May of 1980 I went on a mood stabilizer lithium(also called an anti-mania drug) and in May 2007 lithium was replaced by another mood stabilizer, sodium valproate (epilim or valpro: NAVAL). Generally, throughout this statement, I try not to get into fine detail in relation to the individual drugs I have taken over the years, their various names, brands, quantities, types, the associated chemistry and the extensive literature now available on each of them on the internet. 2.11.3 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. 2.11.4 Mark Twain once said that if he wrote all the things about his life it would (a) bore people to death and (b) would be enough to build a mountain. This is also true of this account and I try, as far as possible, to be succinct. 2.11.5 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.‖ 2.11.6 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. 2.11.7 I appreciate, as I say above, the interest, care and assistance shown by a long series of individuals, particularly the relatives and friends in my life, who over the years and as far back as 1963. In that year what I now see as the first clear episode of MD or BPD began to manifest itself. The professional work of those doctors and the personal assistance of those family members and friends has been invaluable and I want readers to
  • 65. appreciate the primacy I give to the work of these special people for their help and support, their saving me from what in any previous age and time period would have been a horrific, virtually end-of-normal-life experience. I want, too, to particularly emphasise the personal care-givers in my consanguineal and affinal families, that is my family of birth and marriage, especially my mother, my first wife and my second wife. These three people were there to help inspite of the difficulties they experienced as a result of their care-giving attitudes and supporting activities. They were absolutely critical and significant others in that wider social context of family, friends and doctors over the years. 2.11.8 I sojourned in these first five years, in that first episode from 1963 to 1968, in a public and private world that was new to me, at least up to September 1968 I felt a certain normality that was rarely in question. From time to time and beginning arguably on 29 May 1968 I sojourned in a place no less strange to me than if I had been among an exotic jungle tribe in Africa. It is the duty of some cultural anthropologists to report on their exotic travels and field trips, whether among the indigenous peoples of this earth‘s Antipodes or to equally remote recesses of human experience among other culturally diverse groups. The account I write here, though, is not so much anthropological; it does not give an emphasis to the eccentricities, the absurd and the bizarre which SAD, P, D, MD and BPD accounts often do; it does not attempt to make a comprehensive statement of my experience. I leave this for my autobiography/memoirs and readers can find the story buried there in occasional references among the 2600 pages much of which is now on the internet in different forms, short and long, paragraphs here and pages there. 2.11.9 As I say above, I came insensibly over several decades--and then only at some distant and abstract level--to associate the extremes of my BPD somewhat with the role of shamans among tribal, third world and animistic communities, people who relate their myths and their meanings by means of emotionally laden quasi-ecstatic visions. On the personal level, I discovered in myself unexpected patience, humility and hope. I learned to treat life as the most precious of gifts, infinitely vulnerable and precarious, to be infinitely prized and cherished. I had not become a shaman or a saint, though; I still suffered; I was still impatient; I did not always appreciate life; I still got depressed. I had journeyed with my body, although I don‘t think with my soul, into an underworld and come back, more times than I care to tell and certainly more times than I tell of here. But I have survived and lived to tell the story. This is not always the case for people with SAD, D, MD or BPD. 2.11.10.1 Mine was a drama which can be described from several perspectives: a psychotic episode, a psycho-neurological, a psycho-pharmacological, a schizo-affective problem. In 1968 the first psychiatric diagnosis, some five years after the beginning of my first episode, resulted in my suffering, my illness, having at last a label, a medical diagnosis, a name attached to it: a mild-schizo-affective disorder, for which I use the acronym SAD in what has become a somewhat long account. 2.11.10.2 This mild SAD, the diagnosis I received in late 1968, I could narrate as a drama in religious/spiritual terms and describe it as a purgatorial dark night. The experience was both a pain in the neck and a gift of the gods, I can now say in retrospect. Whatever it was and however I interpret its meaning in my life, it has unquestionably been a key part of my life. But it was not all my life. I do not define all my life in terms of this disorder. This account is of that part, that small but important part. It is the centre
  • 66. of my chaos narrative as some students of autobiography call such accounts. 2.11.10.3 I found the poet Sylvia Plath‘s description of her hospitalization as "a time of darkness, despair, and disillusion--so black only as the inferno of the human mind can be--symbolic death, and numb shock--then the painful agony of slow rebirth and psychic regeneration," useful. Plath was able to return to college and only graduated a couple of months behind her class. I, too, was able to return to everyday life after those 5 months in a large psychiatric hospital and, within 2 months was employed with a security firm, within 4 months as a systems analyst, within 8 months as a teacher and within 5 years as a tutor at a university. Plath wrote about her BPD, about her losing her grip on sanity and regaining it, about her ECTs, about the people who tried to help her in the form of poetry in her 20s. She was obsessed by death. It was not until I was well into this lengthy account that I was aware of her BPD. There are, of course, many other poets who had BPD and committed suicide: Anne Sexton, Sara Teasdale, and Sara Kane, among others. 2.11.11 It is unfortunately very trendy now to attribute mood disorders like BPD to personality and spiritual illnesses. From my point of view such attribution is done by people who don't research into what is the real cause of BPD. Their understanding of the disorder is limited. Sometimes the negative stigma and the inaccurate attribution hurts more than the actual disorder. It can be very disheartening to see a negative stigma continuing in a community and in individuals. Given the complexity of BPD such an attribution is not surprising. Like so many things in life BPD is just one of the many very complex phenomena and people can‘t be expected to understand all of life‘s complex medical disorders and social problems. 2.11.12.1 Stories in life, all peoples‘ stories, have a chaotic and confusing aspect at a certain level of analysis, a problematique as some social scientists call the story of one‘s life, especially in the absence of some kind of narrative order, an order imposed or simply narrated in a simple fashion. Even with some order, imposed or not imposed on one‘s experience, one‘s life is still a problematique. I tell my own story here as briefly as possible to help establish, for me, some of that sense of order. I tell of these events, as a storyteller might, of my experience of life, but it is a story not packaged for the media. It has been packaged, though, in several written forms for the internet at some 100 sites from 2004 to 2012. I try as I get older to use soft words and hard arguments both in my writing and in my speech. This is a good goal for people with BPD. Softness, tact, kindness and gentleness are often absent from the behaviour and speech of sufferers from BPD. This has certainly been true of me in the half century trajectory of my experience of BPD. These qualities are still absent at crucial times, but so is this true of billions of others who do not have BPD. 2.11.12.2 At some of the postings of my story, my experience, on the internet there is only a brief statement and at other sites the statement is as long as this one. As in life, so on the internet: not everything a man knows can be disclosed; not everything that can be disclosed is timely and not every timely utterance is suited to the ears of the hearer. This definition of tact from the writings of Baha‘u‘llah is most apt here. I have used this 90,000 word statement or parts of it for other purposes. Without sequence, without narrative form, without analysis of some kind and some attempt to frame a discernible causality, one‘s story remains a bit of a jumble to say the least. 2.11.13 Of course, not everyone looks at their life experience this way. We are a highly
  • 67. diverse species and not everyone is inclined to write an account like mine, if they write their account at all. In my experience over all these decades with this illness, I am inclined to the view that very few ever write their story in even an abbreviated form. We are a highly diverse species, as I say above, and we see, experience and understand things in so many different ways. Life has an element of mystery, of jumble, no matter how much knowledge and understanding we bring to our problems and whether we write an account of our life or whether we don‘t. There is so much, too, of the practical that one needs to learn to implement if one has BPD. The old English proverbs are pertinent here: ―A full cup must be carried steadily;‖ and ―A Smooth sea never made a skilled mariner.‖ 2.11.14.1 And so, as I say, this story is what could be called my chaos narrative. Certainly studies in autobiography and biography, as I say above, are now classifying this very popular genre into many sub-types. Autobiography and its several forms of life narrative, memoirs and diary, inter alia, is arguably the most popular genre of the last several hundred years. One sub-category of the genre of life-writing is the chaos narrative. It is written after the excesses of the chaos have gone; the experience of the extremes of the chaos are incompatible with the writing or the telling. To put this another way, it is difficult to write the story while in the midst of some of the more extreme parts of the experience. 2.11.14.2 People like the famous dancer Nijinski, among others, have placed their experience in a written context during their suffering. But I could no more have written anything when in the summer of 1968 I was placed in a locked and padded room to protect myself from myself; or in the winter of 1978 living in Ballarat, an old gold- mining town in Australia, when I hid under the sheets of my bed on getting home from work feeling, as I did, a sense of acute paranoia every day. The paranoia was not experienced all the time but certainly enough of the day to make the day one that was difficult to cope with in my ordinary employment and family situation. As I say, some write in the midst of their chaos, but this is not the case with me in this account. 2.11.15 Those who are living in the midst of bipolar episodes are now telling of their experiences more and more in recent years as they come-out and as BPD becomes more a part of public knowledge. Their stories are often bizarre, but in this crazy world sometimes their stories are only one of many kinds of traumatic, bizarre and extreme forms of suffering that the world is drowning in at present. The chaos that I describe in the distant past is told here in the relative and retrospective tranquillity of the present. Living in the midst of chaos, to emphasize this point for a final time, makes reflection, and consequently any attempt at narrative for oneself or others, difficult if not impossible. 2.11.16 Telling and, even more so, writing is a way of taking control and creating order, thus giving an account of what was once experienced as chaos, but now has a framework of meaning. To some extent, as a famous psychiatrist Dr Victor Frankel once put it, suffering ceases to be suffering, the moment it finds a meaning. That is partly true and even if it is entirely true it is not always seen that way by the sufferers. But Frankel‘s words apply to me in a significant way and this is partly why I write this account here. Without one of the main strands of medicine, though, namely orthodox psychiatry behind me and its pharmacological strand I don‘t feel I would even be here to tell my story.
  • 68. 2.11.17 The longest intense D(depression) I had was in 1963 and 1964 with perhaps two six month periods from June to November and July to December, respectively. The longest episode of some combination package that came to be labelled a mild schizo- affective state, a combination or alternation of mania and depression among other symptoms, was a part of my life from June to November 1968. This episode also resulted in the medical characterization of my illness, as I say, a SAD with the adjective mild placed at the front of the term. The episodes of H in 1977 to 1980 and 1990 were treated more quickly with medication, although the 1977/8 episode, beginning in December/January, seemed to last for at least three or four months and had a mostly depressive component. It was treated with trifluoperazine, under its brand name stelazine, another anti-psychotic medication and the side effects were horrific. Only the 1980 episode required hospitalization in this case for one month in May of 1980. 2.11.18.1 This narrative, this account, tries to give voice to what is complex and, in some ways, very difficult to understand. I do not want to glorify this experience, but I do want to describe its tortuous, debilitating and life-threatening pathology. I do want to tell of what is, in many ways, a normal reaction to both difficult external circumstances and bio-chemical factors inherent in my body physiology. The project of writing about this life-long trauma is difficult and riddled with paradoxes and contradictions, but it has been indispensable to take on the act of writing even as it has been incomplete and impossible to fully understand. The repercussions still continue to evolve even in the process of describing its history in my life. 2.11.18.2 The society we live in is chronically traumatized and there is a need for narrative forms that accommodate this reality. This personal story is but one of these forms. I try to present the unpresentable in as thorough and complicated a manner that does as much justice to the pathology as possible. 3. Enter Lithium in 1980 and Then Fluvoxamine in 2001: 3.1 Lithium was and is, arguably, the central pivot in this whole story, at least to this point in my life at the age of 69 as I live through these middle years, 65 to 75, of late adulthood, a period some developmental psychologists characterize as the years from the age of 60 to 80. I was on lithium for twenty-seven years: from May 1980 to April 2007 a little less than 40% of my total lifespan. I have experienced the symptoms of this disorder, this partially genetic disorder, with the label MD and then BPD for 33 years(to 2013 and in all likelihood until my death). 3.1.1 There were at least an additional 17 years(1963 to 1980) during which I was not diagnosed with BPD, but during which I had a range of symptoms and experiences I have described above and which were diagnosed(after 5 years of various symptoms) in 1968 as a mild SAD. 3.2 By 1969 I had been treated and I was ready to re-enter society which I did as a security guard on what was then Canada‘s tallest building in Toronto. And so, this made 70% of my life, 46 out of 66 years during which I manifested some obvious features of a disorder of some kind: SAD, D, MD or BPD—not every month or every year but at various times in these 44 years.
  • 69. 3.3 My mood swings came to have an entirely different typicality in 2001, in 2007, and again in 2012. After eight months on the sodium valproate/fluvoxamine package of medication, my emotions, my feelings, were of quite a different order. Valproate has an antimanic efficacy; it lowers aggressive tendencies and impulsive-risk-taking behaviours; it may also be effective in treating my depressive symptoms concurrently. 3.3.1 The death-wish, for example, which I had lived with periodically and in various degrees of intensity since at least 1963, diminished even more after 2007. This death- wish possesses now in 2013 only a faint trace of its past heat and power. It has not blown away entirely, but its intensity has significantly diminished. As I say, it is as a trace element, so to speak. My mood swings have moved into new territory yet again. The luvox in 2001 took my nighttime blackness away and the colouration of my emotions late at night became grey; luvox(fluvoxamine) was added to my medication package that year. 3.3.2 I make no attempt here to describe the phases and intensities of the death-wish in those many years of BPD. Before the official diagnosis of manic-depression in 1980, the death wish was not as dominant. I allude to it but do not describe the experience in even the most cursory fashion. In addition, I should emphasize here that the term episode is a variable one and really needs a separate analysis, if this statement is to be as comprehensive as I would like. 3.4 There is very little high-quality evidence to guide prescribing for older people, particularly those with multiple medical conditions for which multiple medications may be indicated for those with various disabilities. Current best practice in prescribing drugs for late adulthood(60-80) and old age(80++), the geriatric patients of the world, relies on regular evaluation of the safety and efficacy of each medication and of the combination of medications for each patient. Functional and cognitive impairment are strong independent predictors and factors of importance. I am now, at the age of 69, in the "elderly" category. 3.5 Inappropriate treatment is a common concern and includes the use of medicines at too high a dose or for too long a period or the addition of a new drug that induces harmful adverse effects through drug–drug or drug–disease interactions. Another inappropriate way of prescribing occurs when a patient is denied the beneficial effect of a known drug on the grounds of advanced age. In such a complex milieu and after many years of dealing with this disorder, I prefer to just leave the treatment regime to my doctor after brief consultations. The inappropriateness of a drug and the inappropriateness of a treatment, the inappropriate quality of a drug were not concerns I took on board after I seemed to be stabilized on this new meds package. I left these concerns to my psychiatrist. I should add here that my wife and I made judgements about the efficacy of my medication changes within the framework established by my psychiatrist six years ago in 11 and 12/2007 during the last two consultations with my previous psychiatrist. 3.5.1 Substantial progress has been made in the past several decades, while I have had to deal with the symptoms of BPD, toward the application of evidence-based medicine. Practice guidelines, which assist providers in clinical decision-making, have played a valuable role in this initiative and my psychiatrist is a man in his late 60s with over 40 years of specialist interest in clients with BPD. The attributes of good practice
  • 70. guidelines, their role in the skill repertoire of my psychiatrist as a health-care provider and the limitations of practice guidelines for psychiatrists in general are concerns I do not have. 3.5.1.1 I was confident in my psychiatrist and the treatment he provided in the years 2001 to 2012. As a client it is important for me to know that my psychiatrist has some theoretical bases for his clinical interactions and that he is able to shift from one to another as appropriate. The philosophy of my psychiatrist is that of seeing how everything has its place. He tries to figure-out how all my experience and his knowledge fit together in light of his clinical experience with clients who have BPD. It is important for me that my relationship to him be therapeutic, for my confidence in him to be there, for there to be some basic sense that ―this guy knows what he is doing.‖ At the same time I want to see myself, in many important ways, as the expert in my own experience. The therapeutic relationship is itself is not constructed as a power struggle, like a game of 'tug of war.' 3.5.2 And so the quality of the therapeutic alliance/foundation is very important; but so too is the theoretical orientation and the particular interventions my psychiatrist makes. After more than 40 years of going to psychiatrists, I find that for me the best therapists are the ones who respectfully meet me wherever I am in the process of addressing the problems that brought me in, and the most important skill is attentive listening and reflection, along with the willingness and ability to ask hard questions in a kind way. Now in the evening of my life, in the middle years(65-75) of late adulthood, the years from 60 to 80 as some human development psychologists call these years in the lifespan—I am happy to receive the professional help of a psychiatrist and his expertise in medications. I do not seek out the several talk therapies found in the world of clinical psychologists and psychologists. 3.5.2.1 Perhaps some of the problems I had in the last six years, 2007 to 2013, problems that resulted from my meds package, could be laid at the feet of what is sometimes called the ‗dinosaur syndrome.‘ This is an experience BPD sufferers have who place themselves in the hands of an old psychiatrist well-rooted in his ways, using the same tactics that he was taught and has used for many years, indeed decades. My psychiatrist during the decade, 2001 to 2012, was a scholarly man and kept-up with his journals, but he is not on the internet and cyberspace has become a world of information even for specialists. By 2008, I had become comfortable with him and only went to see him about once every two or three years--when I felt the need to chat about my meds. I also became comfortable with the meds he had prescribed in that decade. In April 2012, as I say elsewhere, I had a new psychiatrist. In 2010 I began to consider going to this new psychiatrist for a second opinion; I gradually obtained all the necessary information and the referral form my GP. But it took more than two years to decide to change from the old to the new psychiatrist and go on new meds. I will report on this new line of action below. 3.5.2.2 After chopping and changing psychiatrists, meds and life-narrative situations in marriage, family and employment from the 1960s to the 2010s, I became tired of the various manifestations of BPD over its several decades in my life and I was happy just to leave my sodium valproate(for BPD) and effexor(for OCPD and depression) package as they were even though this new package had significantly altered my behaviour and life-
  • 71. experience. My story is a long one and I had no desire for endless chats about it, more detailed and written analysis or much internet participation. After a decade on the internet and joining many sites, I have come to limit my cyberspace participation in the mental health domain. My attitude with: my GP, my psychiatrist, my wife and with anyone who wants to engage me in a discussion on the topic of my BPD---has become in summary: ―let‘s just refine the meds, if necessary---and I can go home.‖ On 5 August 2010 my wife and I decided to refine the meds. I doubled the quantity of effexor from 37 & ½ mg to 75 mgs due to an outburst of anger and invective on 4/8/‘10. In April 2012, I change the meds pkg entirely. In the period between 4/8/'10 and 4/11/'12, 27 months, I got out of control twice. In the following year on the new meds I got out of control once. 3.5.3 There has been a lot of research on practice-based evidence vs. evidence-based practice. What's being learned is that real rapport between client/therapist determines 60% of the success of the therapy, 30% is based on the interventions the therapist uses and the remaining 10% is how much faith the therapist has in those interventions. Session Rating Scales have begun to be used. They are designed for clients to assess the key dimensions of the therapeutic relationship. Outcome Rating Scales have been designed to measure the area of life functioning known to change as a result of the therapeutic intervention selected. These instruments can be used by psychiatrists to obtain feedback from their clients but my psychiatrist has not used them yet. 3.6 Some critics of psychiatry argue that only a small percentage of psychotherapy services are tightly linked to existing scientific knowledge in the same way that, say, surgery and many other fields of medicine, are linked. This problem, say these critics, has multiple faces. The fields of psychology and psychiatry have a hard time agreeing on what we even mean by mental disorders. There is a proliferation of theories and approaches. Different theorists have different axes to grind, so to speak. Managed-care companies have practice guidelines but often they just come down to ways to reduce cost. The American Psychiatric Association has practice guidelines, but medications are so emphasized that as a broad public information service, they are not very useful so continue these same critics. (For the following paragraphs I thank Steven C. Hayes, ―Exploring Sensible Alternatives in Evidence-Based Psychotherapy,‖ The Huffington Post, 16 March 2011.) 3.6.1 There are at least two government efforts worth noting in the area of psychotherapy, and fortunately both are exploring acceptance and mindfulness-based alternatives in the area of evidence-based care that give consumers a wider range of choices. One worthwhile effort is by the Veteran's Administration(VA) to learn how to train, supervise, and monitor the impact of evidence-based practices when they are implemented in the VA system. It is a beautiful and well-organized project. The VA has put millions into selecting a small number of evidence-based methods to deploy throughout their system, training hundreds of clinicians in these methods, measuring whether they have acquired and continue to use the actual skills (not just talk the talk), and then examining whether these methods lead to good outcomes for veterans. 3.6.2 One method that VA has developed known as Acceptance and Commitment Therapy (ACT), is one of the handful of methods the VA has decided to try to roll out into their systems of care. The results are not in yet. Unfortunately it takes a long time for the VA to share what they have learned -- the VA is bureaucratic, to say the least. Within the next year or perhaps two we should learn what happens, positive or negative,
  • 72. when ACT (and other well-known evidence-based methods, such as prolonged exposure or cognitive therapy) are implemented systematically in a large system. It could be a very important series of reports. 3.6.3 Right now in the U.S., the only publicly available and generally applicable governmental process for recognizing evidence-based mental health interventions is maintained by the U.S. Substance Abuse and Mental Health Services Administration. It is called the National Registry of Evidence-based Programs and Practices (NREPP). After a three-year review process, ACT was finally listed by NREPP an evidence-based practice. For the complete report on ACT, visit the NREPP website.). Here is how they describe ACT: ACT is a contextually focused form of cognitive behavioural psychotherapy that uses mindfulness and behavioural activation to increase clients' psychological flexibility -- their ability to engage in values-based, positive behaviours while experiencing difficult thoughts, emotions, or sensations. ACT has been shown to increase effective action; reduce dysfunctional thoughts, feelings, and behaviours; and alleviate psychological distress for individuals with a broad range of mental health issues (including DSM-IV diagnoses, coping with chronic illness, and workplace stress). ACT establishes psychological flexibility by focusing on six core processes: • Acceptance of private experiences (i.e., willingness to experience odd or uncomfortable thoughts, feelings, or physical sensations in the service of response flexibility) • Cognitive diffusion or emotional separation/distancing (i.e., observing one's own uncomfortable thoughts without automatically taking them literally or attaching any particular value to them) • Being present (i.e., being able to direct attention flexibly and voluntarily to present external and internal events rather than automatically focusing on the past or future) • A perspective-taking sense of self (i.e., being in touch with a sense of ongoing awareness) • Identification of values that are personally important • Commitment to action for achieving the personal values identified 3.6.4 ACT is the evidence-based method, some argue, for people who don't like evidence-based methods. If traditional cognitive behavior therapy (CBT) methods have been tried and have failed, there is no reason to give up on science. ACT and the other acceptance and mindfulness-based forms of "contextual CBT" prove that evidence-based approaches can include a wide variety of methods. Consumers can care about science and still have a choice. There are literally scores of ACT self-help books available, from many different authors; there are thousands of ACT clinicians around the world and many more in sister approaches such a Mindfulness Based Cognitive Therapy or Dialectical Behavior Therapy. Modern acceptance and mindfulness-based methods are giving consumers a sensible,
  • 73. evidence-based alternative to dealing with their suffering, and that is a big step forward (for more information on resources available see the website of the scientific society developing ACT.) 3.7 NAMI, the National Alliance on Mental Illness, issued a report: ―Grading the States in 2009: A Report on America's Health Care System for Adults with Mental Illness.‖ This is a very enlightening report and an informative website and it gives people with BPD a general picture of the quality of treatment programs in the USA, a picture like the one here in Australia where I have lived over half my life, half my experience with BPD. 3.8 The symptoms that affected my daily working capacity, even now, are fatigue, psychological weariness and lack of emotional control in the area of anger. Anger, though, since going on my most recent medications, has been virtually eliminated, it has not been entirely eradicated from my experience. A night of light sleeping, tossing and turning or what some call agitation insomnia tends to make me want to go back to bed during the day, and I usually do for about 2 hours. This has not been the case since April 2012 on my most recent medication. After varying lengths of time in intellectual activity, 2 to 3 hours on average, I also had to go to bed, but not since 4/'12 on my most recent meds. One can hardly complain, though, given that this fatigue, these experiences, psychological and/or physical weariness, are the lot of Everyman to some degree and in a myriad of different patterns. My story, my experience with sodium valproate, my lithium substitute, began six years ago in April of 2007. Effexor was introduced into the medication package in May 2007 to replace the luvox. Sodium valproate is a mood stabilizer & effexor an anti-depressant medication, but more on these drugs is found later in section 4 below as well as on the internet for interested readers. Effexor(venlafaxine) is also used to treat OCD. My OCD behaviour seems to have increased since going off the lithium. This may be OCPD, obsessive-compulsive personality disorder, which I have discussed earlier in this account. This 90,000 word statement deals only tangentially with the OCD and OCPD behaviour in my life. 3.8.1 Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder characterized by either obsessions (recurrent or persistent unwanted thoughts, images or impulses) or compulsions (repetitive behaviours or mental acts often performed to relieve anxiety or distress). The obsessions and compulsions of OCD cause significant distress to the afflicted individual. In my case the distress is minimal. Once believed to be rare, OCD is now estimated to affect between 2 and 3% of the general population and is the fourth most common psychiatric illness (after specific phobias, substance abuse and major depression). Patients with OCD have a poorer overall quality of life, and experience significant impairment in academic functioning, work performance and interpersonal relationships. In fact, OCD is estimated to be the 10th leading cause of disability in the world. The introduction of SRIs and behavioural therapy techniques have improved clinical outcome in many patients. Due to what I regard as a low level OCD I have not sought treatment for my OCD. 3.9 Since 1980 and more so since 1990 I have had little difficulty knowing where I was in the process of mood swing, psychological orientation and general understanding, although in the decade beginning in 2001 on the new medication packages I kept having to make adjustments in both the meds and in orienting myself to where I was at, so to
  • 74. speak. The chemistry and the relationship with brain functioning which is involved with BPD is very complex and I make no attempt to describe the chemistry, the anatomy and the physiology here in this document except in the most cursory fashion. Over the years I had grown used to the various plays on my emotions, my sleep patterns and my mental activity during the pre-medication phases and shifts as well as the post-medication periods of the medications prescribed. During the mood transitions and the medication changes, the swing to a mild elation or euphoria was new, refreshing and quite pleasurable. The initial period of a few weeks when changing to NAVAL from lithium there was a period of instability and highly variable sleeping patterns and problems. During this transition there were a variety of symptoms, but I feel no need to outline them here. 3.10 The transition to the medication package in 2007 was very different than the one in 1980 or the second major shift in 2001—with the addition of luvox. The great intensities of swing had virtually gone by 1980, although the blacknesses late at night remained. After the introduction of luvox, though, as I said above, these blacknesses disappeared. Total acceptance of the necessity of taking lithium was a critical variable in this process and it took the decade of 1980 to 1990 to achieve. At the hypomanic end of the continuum over the years there were experiences like the following: violent emotional instability and oscillation; abrupt behavioural changes and a sudden change in a large number of intellectual assumptions; elation, high energy and various forms of excess. Mental balance, a psychological coherence between intellect and emotion and a rational reaction to the outside world all seemed to blow away, over a few hours to a few days, as I was plunged in a sea of what could be variously characterized as: emotional heat, intense awareness, sensitivity, sleeplessness, voluble talking, racing mental activity. 3.11 What I have described briefly above was my hypomanic personality at one end, the extreme end of the spectrum. At the other end of this same spectrum: fear, excessive paranoia, incoherence, intense depression or melancholia, despair and a desire to commit suicide were the major symptoms. This BPD spectrum includes a large number of mood disorders. The reason there now are so many different categories of BPD is partly due to this spectrum approach. With more reflection in the months and years ahead I may come to define my BPD experiences over the last half century along this spectrum more precisely. In the years from 1963 to 1965, in 1968, in the years from 1977 to 1980, when I went off lithium in 2001 and began a new series of medications from 2001 to 2012, I could utilize several labels from the psychiatric literature. BP I, though, is the main label. For now I shall not go down this road at this point in this statement. 3.11.1 A hypomanic episode is defined as a distinct period of persistently elevated, expansive, or irritable mood, lasting at least 4 days, that is clearly different from the person‘s non-depressed mood. In general, hypomania is not severe enough to cause notable problems in social activities, work or to necessitate hospitalization, and there are no psychotic features. Indeed, hypomania is a rich and delightful state in many ways: energy, confidence, joy. With another medication cocktail in 2010 I felt I had obtained the best of all possible worlds: some hypomania and a balance of energies. After 5 yearsw of what I then thought as "the best of all possible worlds," I slowly became disatisfied and, in April 2012, I went on yet another medication. 3.11.2 The term suicide ideation or suicidality is often used here in contrast to actual
  • 75. attempts to commit suicide. I do not deal with this subject in this lengthy essay but, since up to 15% of people with BPD die by suicide and as many as 50% attempt suicide at least once in their lives, I would like to emphasize before passing on in this essay to other topics that suicide prevention involves: (a) decreasing the access to the means to commit suicide and (b) increasing access to support systems like doctors, therapists, family members and friends. 3.11.3.1 Evidence that selective serotonin reuptake inhibitor (SSRI) ‗antidepressant‘ use may elicit suicidal thoughts and behaviours in people of all ages has been circulating since I began taking lithium in 1980. Luvox and effexor are SSRIs and I have not noticed any significant increase in suicidal ideation in the dozen years I have been taking them. I have lived with suicidal ideation, or what some call the death wish in many different time-frames, for 50 years now(1963 to 2013) and the SSRIs have actually decreased the black thoughts to grey before going to sleep, taking the heat out of the death-wish. 3.12 Memory Loss: 3.12.1 I was a classroom teacher and educator for over thirty years(1967 to 2003) and I have seen a good deal of short term memory loss in both myself and my fellow man and the myriad reasons we all give for forgetting, some justified and some not-so. The experience of memory loss in my own private domain, though, may be the result of: (a) the several medications I have had since 1968 and (b) the eight ECT treatments in the summer and autumn of 1968. But, again, everyone has memory problems; a recent test in 2005 administered by a doctor specialising in treating memory loss in geriatric patients, did not indicate any particular memory difficulty or the onset of any illness associated with memory loss, like altzeimer‘s disease, a disease with its own trajectory of memory problems and functioning. 3.12.2 My current psychiatrist, who specialises in treating people with BPD and who has been providing his professional advice to me for the last nine years, after a series of psychiatrists I have had going back to that period in 1968,3 does not think my memory problem is a central or even a peripheral part of my bipolar symptoms. If anything, my problem of memory has its origins in causes other than bipolarism. This was the same conclusion of that specialist in geriatric care, as well, whom I saw in 2005. After more than half a century of evidences of bipolarism in my life, I am inclined to think that my memory loss is, again, not something that should concern me unduly in this account of my bipolarism--even though it has been a practical concern in my daily life and I would like to say a few words about that problem in the following section. 3.12.3 My memory problem does contribute, as readers may appreciate, to many practical problems in day-to-day life. My wife is very aware of these problems which we have come to associate with: (a) selective memory, (b) inattention, (c) poor listening skills, inter alia. I mention these things because my bipolar disorder is largely treated. Whatever memory-loss I exhibit I do not regard as attributable to my BPD or the ECTs I had back in the 1960s, there is still a constellation of physical and psychological difficulties remaining, in addition to the residue of bipolar symptoms that are still present in my life. I do not want to emphasize these problems, this constellation of difficulties. These more peripheral problems detract from the central theme of this account. Their relevance is indirect though, I must emphasize, they are not irrelevant to the way I experience my life.
  • 76. 3.12.3.1 Forgetfulness, distractibility and impaired executive function are manifestations of the normal ageing process in both humans and monkeys, and can be observed as early as in middle age. This decline in working memory is associated with prefrontal cortex dysfunction, but the underlying molecular basis was unknown until now. 3.12.4 Some research into BPD suggests that decreased working memory performance exists in BPD patients. This is reflected in specific neuro-functional deficits. These deficits may represent primary areas of neuropathology or be secondary to neuropathology elsewhere in the working memory network. Continued research utilizing other imaging modalities may further clarify the underlying neuropathology involved in these cognitive deficits. 3.13 More General Comments: I have a file of detailed notes on doctors‘ visits, various treatments for various problems and background information. It is a file I opened in 1999 on my retirement to assist me: (a) in treating myself for particular medical problems that arise and (b) to compensate for the memory problems I have mentioned above which I experience in relation to the several problems I have had that required visits to the doctor. Visits to GPs and my psychiatrist required several treatment regimens and I needed some system to record items I could not remember. But I have not commented on these notes nor included them here. The focus in this account of more than 75,000 words is on my bipolar problem and not any ancillary difficulties some of which are related to my BPD, like my chronic renal failure, but most of which are not. 3.13.1 It seemed appropriate to outline this detailed statement of my experience with BPD for several purposes since the issue of the nature of my problem and what was once called MD, at least until the 1990s, is a complex one. The story varies from person to person and has been of concern to me over the sixty-five years that I have had to deal with its symptoms in my personal and professional life. Others close to me, some of whom are now called care-givers, have also had their concerns It is difficult to characterise my condition and it is for this reason that I have written what some may find to be an overly long statement. As I say above, I write this for both my satisfaction and the use by others, especially those who suffer from BPD. 3.13.2 I hope this account, in both long and short term contexts, will explain adequately my reasons for not wanting to work in any employment position or participate in any demanding social context. It was for this reason that I drafted the first edition of this essay, this account, ten years ago now in 2001. This account, now in its tenth edition may provide those interested, as I also say above, with some useful information for dealing with their own particular problems, perhaps even problems not associated with bi-polarism. 3.13.3 I have a file, as I say above, of detailed notes on doctors‘ visits, various treatments for specific problems and background information. It is a file I opened in 1999 on my retirement from FT work to assist me in treating myself for particular medical problems that arose and to compensate for the memory problems I experienced in relation to the several medical difficulties which arose from my mid-fifties onwards. Visits to GPs and my psychiatrist required several treatment regimens and I needed some system to record
  • 77. items I could not remember. But I have not commented on these problems and medical details here. The focus in this account is on my BPD and not any separate or ancillary difficulties. 3.14 The Process: 3.14.1 There seems to be a process, one of immense variability, that I have experienced on a daily basis for arguably, 67 years. The details, the symptoms, the behaviour, varies from year to year, with the decades, with the days and especially since my first D in October 1963 and since the medications I have been placed on since June of 1968. I cross from some normal behavioural constellation to an abnormal, intense one. The abnormal extreme position varies, as I say, from day to day, month to month and year to year in content, texture, tone and intensity. In 1946 it was characterized by uncontrollable early childhood behaviour and eccentricities. My mother had to deal with these aberrations. 3.14.2 Looking back to my childhood I did have some behavioural abnormalities, but their association with bipolarism is also, I tend of think, unlikely in retrospect. Behavioural abnormalities in children and adolescents are also as common as air and it seems to me, at this stage of the understanding of my disorder, that to impute bi-polarism may be premature at best and simply incorrect at worst. The diagnosis of bipolarism at that early stage of my life in 1947 at the age of three is only a remote possibility given that only 1% of people with BPD are considered to have exhibited BPD behaviour during their childhood or adolescence before their late teens. More knowledge of this disorder may yield a different conclusion at a future time especially since children and adolescents have been increasingly given the label, the diagnosis, BPD in order to explain their medical/behavioural problems. The lack of reliable screening instruments in my childhood and adolescence that could have assessed my several mood, anxiety and behavioural conditions within the spectrum of a possible BPD was one of the problems in identifying conditions at these earliest possible points in time for effective intervention. If you are one of the many individuals who struggle with mood and anxiety symptoms as well as/or fear and anger--identifying your particular problem and beginning effective treatment can help you get back on track. For now, though, I leave this issue without further comment. 3.14.3 At the moment, at the age of 69, the negative aspects of my BPD are several, but I will go into these details, these more recent manifestations of this disorder, at least since 2001, in the next section of this essay, section 4. Due to the above "process" over more than sixty years, due to the part of the process which occurs in varying degrees in various accentuated forms, it has often been difficult to define just where I was at any one time along the 'normal-abnormal' continuum—and it still is. This was true at both the depressive end and the hypomanic end of the BPD spectrum. 3.14.4 It is difficult, therefore, to actually name the number of times when I have had major manic-depressive episodes. Perhaps the number is as many as eight. Certainly it is at least four in my whole life from what may have been the first episode in 1946 to the last brief episode in 1990 when I went off my lithium for between one and two months. Defining an episode is not easy for me to do; indeed, the concept of episode is only useful in some respects. In other ways it over-simplifies a complex set of behaviours; it
  • 78. has value, though, when trying to describe the experience in writing. The term episode serves as a sort of shorthand, a paradigmatic sign and symbol to cover a broad range of behaviour and over a wide set of time spans under one rubric. BPD has a complexity that has required, at least for me, medications, time, the wisdom of experience and, in some ways most importantly, a high quality carer to provide relevant feedback and understanding. These have all been keys, among others, to help me find the stability I so desperately craved from time to time. 3.14.4.1 Recent advances in computational neuroscience have led some psychiatrists to consider that the unusual perceptual experiences of BPD sufferers and their sometimes bizarre beliefs as part of the same core abnormality. This view results in seeing such experiences as a disturbance based on cognitive errors requiring an updating of inferences and beliefs about the world. 3.15 Some Things I Have Left Out: 3.15.1 The account above has none of the fine detail that I could include like: (a) details about my mental and auditory hallucinations during my psychotic episodes, (b) a long list of specific low-range fears and high range paranoias, (c) the electroconvulsive therapy, E.C.T.s I had back in 1968, (d) details of the developmental aspects of the various treatment regimens I have been given over the years, (e) the various psychiatric analyses and diagnoses, (f) the many years of dealing with suicidal thoughts and what some call a death wish, (g) experiences in and out of half a dozen hospitals, visits to unnumbered doctors‘ clinics and listening to advice from well-meaning but usually misinformed or uninformed people than I care to recall, (h) adjusting to medications that varied from those which heavily sedated me and simply put me to sleep, to those which made me high, increased my sensitivities and sense of awareness of my environment— and still others that resulted in a state of paranoia, nausea and a sense of utter terror among other side-effects; (i) the effects of these many swings and mood changes on my employment, my relationships, my two marriages and my attitude to life; and (j) the problems in community life are difficult to untangle and describe here and would unduly lengthen this account. 3.15.2 The effects of BPD on my two marriages were many: too high a libido and in my case too extensive a demand for sex; a tendency to anger and additional strains and stresses. How much of this was due to my BPD is difficult to quantify. The effect on my employment was, again: anger, the temptations of the opposite sex and the desire for greater stimulation/satisfaction in my working life in general as well as a greater drive to succeed, to achieve. Motivation is a complex phenomenon and the relationship between work and its demands, BPD and my several manifestations of this disorder during the period from my birth to the age of 18. 3.15.3 Many of the situations, looking back, were humorous and the contexts absurd. And there was much else but, as I indicate, I hesitate to go into more detail. My aim here is to make a short(not short enough I hear some readers say!) clinical statement, to put some basic facts on paper, to outline some impressions, to make some analysis and draw some tentative conclusions. Perhaps later, in a further essay or posting on the internet-- for this is the place my writing on BPD as a non-professional gets the most exposure--I will go into the kind of detail some readers have already requested. And so--I want to make this statement as short as possible, but as detailed as I can, to give a longitudinal
  • 79. perspective. At 75,000 words this account has become far from short, but it serves my purposes even if it is onerous for some readers to digest. I find, after several years of internet posting, that readers who find my account too long simply don‘t read it. There is plenty of material on the World Wide Web for sufferers of BPD who require short posts, simple advice sketches and quick back-and-forth chat settings. 3.16 Different BP Profiles and Typicalities: 3.16.1 There are a variety of BPD profiles, what you could call different behavioural typicalities from person to person of those diagnosed as having BPD. It is bipolar because both ends of the spectrum, the moods, were and still are experienced over the period 1943 to 2011, 68 years. Thanks to lithium(1980), fluvoxamine(2001), sodium valproate(2007), venlafaxine(effexor)(2007), and seroquel(2012)---most of the extremes are now being treated. Beginning: (i) at the age of 19 in 1963, then (ii) at the age of 34 in 1978, (iii) at the age of 57 in 2001, (iv) over the 60 month period 4/2007 to 4/2012 in these years of late adulthood and, finally--(v) in April 2012 to a meds pkg of seroquel and effexor. It was my hope that this was to be the final major shift in that twenty year period in the human lifespan from 60 to 80, different medication regimes have resulted in an experiencing of life in very different ways. They brought me back to a centre, a normality, but I was somehow, somewhat mysteriously, inexplicably in some ways, never the same again. By 2010 I had developed a marked asocial tendency which I refer to elsewhere in this document. Different medications affect different people in different ways, ways that this statement refers to briefly insofar as my life is concerned. This of course is true of all of us, each in our own ways, with our own stories of change, of crisis and our own expressions of an often difficult to define normality and abnormality. 3.16.1.1 As I pointed out in a footnote to my introduction, the diagnosis that has been made in my case is a diagnosis that is standardized according The Diagnostic and Statistical Manual of Mental Disorders(DSMMD), 4th edition. There is a five axis system of diagnosis that is used in that manual and I refer readers to that manual and that five axis system for a more comprehensive view of just what I have left out of this statement. In my case: axis 1 is for clinical disorders in my case a mood disorder; axis 3 is for general medical concerns that relate to my BPD, axis-4 is for psycho-social and environmental problems that relate to my BPD and axis-5 is an overall caregiver‘s assessment of my functioning on a scale 1 to 100. 3.16.2 It took ten years, from 1980 to 1990 as I say above, for me to fully accept the lithium treatment. From time to time in the 1980s I tried to live without the lithium, to go it alone, to go off it on a cold turkey, as they say colloquially. Such, in as brief a way as possible, is the summary of my experience over the years and, in the main, up to 1991. I have written more extensively of these years, and especially the issue of acceptance of one‘s BPD and compliance with medication in my autobiography which is readily available on the internet for anyone who is interested. 3.16.3 Individuals with BPD have several characteristics that make them more vulnerable to substance abuse, addiction and compulsive behaviours. There is, therefore, a higher prevalence of people with BPD who have: (a) addictions, (b) OCD and (c) a higher vulnerability to substance abuse. As I have emphasized in this account, the experience of individuals with BPD, while having symptoms in common, is also highly diverse in its characterization. Over more than half a century now I have experienced, at
  • 80. various times: agitation and anxiety, aggressiveness and anger, belligerence and battle- fatigue, confusion and compulsiveness, impulsiveness and risk-taking, insomnia and irritability irregularity and morbid thought patterns, maliciousness and suicidal ideation, panic, paranoia and persecutory delusions, pressured speech and racing thoughts, restlessness and rage—not all at once, it must be emphasized, but at various times and, as I say, over many decades. One could find all of these behaviours in people without BPD but, for the most part, not in the same person. The concept of a profile of bipolar symptoms that could help clinicians diagnose BPD before an individual has a hypomanic attack as I had back in May-June 1968 is currently the object of the application of state of the art technology to genes across the whole genome. 3.16.3.1 As many as 60 per cent of people with BPD will have some form of substance abuse during their lifetime according to Ken Duckworth, MD, medical director of the National Alliance on Mental Illness(NAMI). When the BPD brain state can vacillate from foggy, unfocused and depressed all the way to hypomanic, hyperactive and manic, the internal environment of the person with BPD is not stable and is difficult to depend on. One powerful coping mechanism is to self-medicate with stimulants like caffeine, Adderall, Ritalin or even cocaine or meta-amphetamines. These stimulants push one‘s brain and body into a state of high alert, often with side effects of mild to extreme anxiety, anger or fear but, at the same time, forcing one‘s brain-state into the state he or she wants at the moment. The emotional complex here is often difficult to describe. This often leads to cycles of substance abuse and addiction. 3.16.4 The behaviour patterns of people with BPD are characterized often by: impulsiveness and sensation-seeking, risk-taking and thrill-seeking, novelty seeking and high exploratory drive, excitability and low levels of inhibition as well as the tendency to take more sexual partners and artistic activity. The term schizotypal personality is sometimes used for people with BPD who have a quirky or socially awkward approach to life. These patterns, it is argued by some neuroscientists, have neural correlates and are driven by individual differences in dopamine system sensitivity. The dopamine reward pathways of the brain are different in people with BPD. 3.16.4.1 Dopamine is a chemical that when released into the brain makes a person feel good. It acts as part of an internal reward system. Dopamine rewards are critical for survival since they provide the pleasurable feelings associated with things like eating and reproduction among other experiences in the lifespan. With dopamine as the driving force, biology has designed you and I to engage in fertilization behavior, sexual activity to make more babies, and urges you to move on to new partners to create greater genetic variety among your offspring. The thrill of a new affair is an example of the release of dopamine into the blood-stream. I have been a faithful husband in my 43 years of matrimony but keeping my control in place has not been easy. My religion, the Bahá'í Faith, has been more than a little helpful in this respect. The intensity of my sexual desires has been a strong one in my life, but I try not to let this activity take an undue amount of my time or my concern. 3.16.4.2 The French sociologist Jean Baudrillard wrote that ―ours is a culture of premature ejaculation‖ which has many meanings outside the sexual domain like the lack of thought before speaking, before much of people‘s activity in life. I could add more about this subject but, again, this aspect of my behaviour is essentially tangential to the central thrust of this BPD account. See: Jean Baudrillard, Forget Foucault, 1977.
  • 81. 3.16.5 As I say elsewhere in this statement, it is not my intention to dwell on my sexual life since, like my job, my family, my relationships and my religion, I regard them all as tangential to the focus on the BPD itself but I cannot eliminate reference to them on occasion since they are in varying degrees relevant to this narrative. Bahá'í teachings discourage pre-marital and extra-marital sex as well as masturbation and homosexuality. These same teachings go on to say that it is a lifelong test to learn to control one‘s animal nature, one‘s lower self and not be a slave to what are in many ways natural urges. Many of life‘s tests and temptations, impulses and instincts require caution and vigilance, self- control and struggle so as not to let the sexual domain and their various activities claim too great a share of one‘s attention. For many, certainly for me, the sexual domain has provided one of life‘s major areas of personal struggle. This has been a battle for me nearly as far back as I can remember, indeed, even back to my middle childhood, the years from 6 to 8 years old! 3.16.6 When a person has BPD their brain does not reward them with a rush of dopamine easily, so they have to go to more extreme measures just to get that experience of well- being. That desperate desire for stimulation is also why many people with BPD self- destruct, engage in increased sexual activity and shopping among other excesses. Finding a creative pursuit that is truly engaging has been, for me, a great remedy for my addictive and OCD tendencies as well as my apparently above normal desire for stimulation. The pleasures associated with the passions: eating and drinking, sexual and sensory stimulation must all be kept within bounds and over my seven decades they have been, for the most part. Unexpressed creative impulses, so many argue, are the driving force behind some of the negative behaviours associated with BPD. On the other hand expressed creative impulses can be a positive driving force and, in my case, this has been especially true under the medication regime of the five years: 5/07 to 5/12 as well as this most recent regime from 4/12 to 3/13. It was also true at other highly successful points/stages in my teaching career: 1967 to 2005. 3.16.6.1 I would like to make two somewhat parenthetical remarks here in relation to creativity, remarks that I would not have made several years ago. Firstly, a phenomenon that has only emerged in society in the last decade, as far as I know, of people actively seeking out a diagnosis of a mental disorder and particularly bipolar due to its association with creativity. Perhaps they are looking for a justification for their own bad behaviour. The phenomena could also be due to increased public awareness through the internet, radio and TV, coupled with the willingness of celebrities to talk about their own personal experiences of mental illness. 3.16.6.2 Secondly, there is an aspect of mental disability that can be seen in some of the views of Martin Luther King's deeper philosophy of life. Instead of actively seeking a diagnosis of mental disorder, King sought to deny it. But he held the view that in our sick society we should be, as he put it, creatively maladjusted. As he said in a sermon on this topic: ―Everybody passionately seeks to be well-adjusted, but there are some things in our world to which men of good will must be maladjusted. Human salvation lies in the hands of the creatively maladjusted.‖ Psychiatrists and psychologists call 'adjusted' those who are able to fit in, those who have the intention of fitting in, of wanting to be accepted and functioning well. The average teenager is obsessed with being adjusted, and so are adults, more than we care to admit: the average corporate employee, the typical professor, intellectual, television pundit. They are all rewarded for being well-
  • 82. adjusted. But this kind of normal thinking, this conformism, is deadly to creativity. The result of such an attitude is that a person would never have a new idea; the past becomes the future, and all problems requiring a person to think outside the box would become insoluble dilemmas. Dr King realized that to solve the problems of human life, especially the deepest problems, like racism, poverty, and war, we have to become, in a sense, abnormal. We have to stop going along; we have to stop accepting what everyone else believes. We have to become maladjusted if we are to become at all creative. Insoluble dilemmas often are the masks for other previously unrecognized problems with simple solutions. Dr King knew what it meant to be maladjusted, psychologically, because he was not normal, psychiatrically. He had multiple periods of severe depression, and twice made suicide attempts as a child. Near the end of his life, some of his staff tried to get him to have psychiatric treatment, but he refused. There are aspects of these ideas of King‘s that are relevant to my BPD story. There are questions and issues which are raised by what King is talking about here: what is normality? what are the problems relating to stigmatization? What does being sane in an insane world mean, inter alia. 3.16.7 The two decades 1991-2012 had several major turning points in my personal experience. The first in 1991 was the beginning of what for me was what is often called total drug-compliance. In my case the compliance was with lithium. I had had, to reiterate, in the first decade of lithium treatment, 1980 to 1990, a problem with compliance. The majority of BPD patients are non-compliant and tend to discontinue their medication after one year often with disastrous results. I had, therefore, lots of company in that first decade for I had discontinued my meds twice in that first decade: 1980 to 1990. BPD sufferers also lose years of productivity, normal health and life- expectancy. The first two factors certainly applied to me, although time will tell the extent to which that last factor will be true in my life. 3.16.8 Failing to educate oneself and/or one‘s family inadvertently contributes to medication non-compliance and, in my case, this led to a serious relapse in 1990, but not to re-hospitalization. Knowledge is empowering and can improve one‘s capacity to react constructively to periodic crises in one‘s disability. This was the case in 1990. The relapse occurred in my summer holiday and by the time this holiday ended I was back on my meds and ready to go back to work due to the uncharacteristic emotional instability—the tears—that I experienced when I went ‗off-my-meds.‘ 3.16.9 From 1991 to 2001 I experienced a decade of euthymia, a term used for relative normality. This decade was much like an earlier decade of euthymia in my life, the years from 1969 to 1978. There is a tendency, and this was the case with me throughout most of the 1970s and again in the 1990s, to view my disorder as having a somewhat benign course. I began to see myself as a ―regular‖ person and my life as normal when I was really dealing with an existing, a quiescent, mental illness. It was very easy to slip into a manic-depressive state, a state with strong emotional-mood swings. These swings occurred in: 1963, 1968, 1978, 1979, 1980, 1991 and two or three times in the last dozen years, 2000 to 2012, necessitating in the process medication changes. 3.16.9.1 Effective prophylactic lithium medication controlled and attenuated my acute mood swings, minimized my sense of continuing distress and, I might add parenthetically, assisted mental health professionals' in simplifying the treatment of my
  • 83. disorder and in prescribing advice which I sought during the 27 years I was being treated on lithium(1980-2007). Psychiatrists were able to fit me into a category without my having to go through some long analysis. In that 27 year period that was all I wanted— ―to get my pills and go home.‖ This may not have been the best attitude to take, but it represented the core of my attitude for most of this time. After seeing the wonderful effects of drug-therapy when I went on lithium in 1980, I was disinclined to engage in much talk-therapy, at least talk-therapy unrelated to the monitoring and adjusting to the several medication regimes I had been prescribed. 3.16.10 The malignant quality of BPD is insufficiently appreciated. It has been insufficiently appreciated by me—and still is--and by millions of other sufferers. The functional impairment found among BPD patients; the havoc and disruption reported to their occupational, family and social lives, suggests that, in spite of adequate drug treatment, disturbing problems persist impeding the optimal emotional growth and development of patients/clients as well as that of their immediate family members. Despite their significant effect on symptoms, lithium and drug therapies by themselves often have little impact on interpersonal problems and various psychosocial stressors that may develop in the course of the illness, an illness that often, although not always, plagues an individual over the person‘s entire lifespan. 3.16.11 It is difficult to lock into, to describe, in this account this aspect of the interpersonal problems and psycho-social stressors I experienced. My account of the impact of BPD on the various facets of my life is really quite complex and I am still trying to work it out, to put into words quite complex patterns of thought and behaviour over many decades. In my efforts to do so readers may find that I jump from time frame to time frame in my lifespan and that I compare and contrast different episodes while juxtaposing them within one particular period of time. Readers may find my account confusing in this regard. 3.16.11.1 I may be able to sort out this problem of outlining a logical and clear delineation of my experience in some future edition of this story as I gradually come to refine this life-writing. But, for now, this current outline of my experience is the best I can do given the complexity of the disorder and how it has been experienced over more than six decades. I also want to be succinct and if I examine in any detail the effects on my work, family and relationships the result would be greater prolixity than has already resulted in this account. 3.16.11.2 In a world of alternative lifestyle options, strategic life planning becomes of special importance. Like lifestyle patterns, life-plans of one kind or another are something of an inevitable concomitant to living in our time. Life-plans are the substantial content of the reflexively organised trajectory of the self. Life-planning is a means of preparing a course of future actions mobilised in terms of the self's biography. The existence of personal calendars or life-plan calendars, in relation to which the personal time of the lifespan is handled is part of this process. As far as is possible I would like to build into this account some sense of a future orientation to my life as I deal with this ongoing BPD. 3.16.12 Visits to psychiatrists over this 27 year period each had their own framework of discussion, but I have not gone into the details of each visit. Most of the visits have hardly been mentioned in this statement because an outline of such details would
  • 84. increase the length of this analysis far too much. I have included the notes from the last two visits to my psychiatrist in appendix 1 at the end of this statement to provide some description and analysis of these visits. 4. My BPD In The Years: 1991-2013 4.1 1991-2001: ―Luvox Arrives in 2001‖ 4.1.1 In the decade 1991 to 2001 I finished my life of full-time employment; I began to seriously reduce my extensive and intensive activities and responsibilities in the social and administrative aspects of the Baha‘i community and its life, as well as other volunteer activities and social involvements. I also began my obsession with writing during this period. Rather than ponder the value of non-compliance with this medication as I had done in the 1980s, I came to a state of full-compliance; I came to appreciate, to fully accept, my lithium treatment. Anti-psychiatry has had many forms since psychology and psychiatry emerged in the last decades of the 19th century and the early twentieth and since pharmacology began to have more and more success in the last half century, say, in the years 1961 to 2011, my years of late adolescence to late adulthood. Like many of the mental illness/distress conservatives, they take a far too extreme position in relation to psychiatry from my point of view. 4.1.1.1 The handbook for mental health professionals lists different categories of mental disabilities and the criteria for diagnosing them. This handbook is published by the American Psychiatric Association. The DSM-IV, The Diagnostic and Statistical Manual of Mental Disorders(DSMMD), 4th edition, which was published in 1994, abandoned Freud for Kraepelin. Most psychiatrists these days use a model with combines behaviourism, cognitive psychology and pharmacological treatment. Some say that psychiatry has been at a pharmacological standstill for decades, although I think this is an extreme position. This manual, the DSMMD, is also the subject of much controversy, a controversy which this 50,000 word statement does not deal with here. 4.1.2 I would now like to focus on my more recent experience of the last ten years, 2001- 2011. In 2001, after two years of an early retirement, my supervising psychiatrist in Tasmania suggested I go onto fluvoxamine maleate or luvox under its trade name, in addition to the lithium treatment. Luvox is an anti-depressant and it had been used in Australia at that time, in 2001, for about five years. Fluvoxamine(luvox) removed the blacknesses, what some have often called the black dog of depression that had dogged my life, mostly late at night, mostly since the late 1970s and which continued even after I went on lithium in 1980. Periodically, as I have already described above in the years 1963 to 1968 I also had these intense blacknesses/depressions. Back in those earlier years, though, these depressions lasted well into my daytime hours and traumatized my experience of work, leisure and family life in varying degrees. 4.1.3 Beginning in 1980 these blacknesses were only at night, from late in the evening— after midnight until early morning. For years I found myself entangled in a cycle in which I needed more stimulants in the morning just to wake up and get going, not because of all the "relaxers" as some people with BPD took the night before, but just as part of my mood-cycle. In the evening, while some others with BPD had extra stimulants still in their systems and who needed even more booze or drugs just to allow them to
  • 85. relax and sleep through the night, I was still super-charged. This super-charge slowly subsided as the evening progressed and, by midnight or 1 a.m. I was into the death-wish state. 4.1.4 The death-wish state has always been associated with the after midnight blacknesses, 1978-2001. It had been this way in the years before 1978 especially during that first episodic period 1963 to 1968 when my BPD condition was undiagnosed, when I had no idea what was happening to me and I was simply trying to get through life— sometimes not very successfully. With the administering of fluvoxamine in 2001, though, gradually the blacknesses, the nightly depressions, disappeared or virtually so. Black became grey as I have often said and grey is far superior to black in the mood department. Only residues, then, of a lower mood remained. The death wish remained as did sleeping problems, but in a much milder form. Like so many things in life, the death wish and mood swings have had varying degrees of intensity. 4.1.5 Coping is the key question with so much of this quite horrific personal experience of depression, for me and for others. Everyone has their key questions, their orientations and philosophies vis-à-vis: (a) the various approaches to pharmacology, (b) the many talk therapies and (c) the myriad alternative medicines and approaches to D, BPD and the various forms/labels given to the varieties of mental illness/distress in the public domain. The level of intensity of the discomfort which one experiences is a key determinant, among others, of how one understands and suffers whatever problem one has and its symptoms. The extent to which one copes varies from person to person and from year to year. This only states the obvious. Such is one of many ways of putting this quite complex idea. It is an idea, a process, not easily described, answered or understood and to expatiate on this aspect of the problem would quickly lead to a greater prolixity than the one in which I have already engaged here in this lengthy account. 4.1.6 Frequent urination and memory problems related, in part and perhaps, to the medications and shock treatments I had back in 1968, were new problems by the year 2001. But the dark and debilitating feelings which I had experienced for so many years late at night from midnight to dawn, were at last significantly lessened. After more than sixty years of BPD and/or manifestations of BPD in varying degrees of intensity, with periodic totally-debilitating episodes, most of the worst symptoms seemed at last, at least in the last eight years, to have been treated. They were not removed but they were successfully managed. 4.1.7 My anger episodes seriously diminished in frequency by the time I was in my early sixties, during the first years of fluvoxamine treatment in 2001 to 2004 at the age of 58 to 60 and especially in the year after I was stabilized on sodium valproate and effexor by February 2009. I changed my effexor levels in the period 2/09 to 8/10, as I mention from time to time in this account. I still had to watch, to monitor, myself because occasionally I still went over the edge and anger surfaced, inappropriate and uncontrolled anger. The manifestations of anger were on occasion a sign of my need to: (a) increase my effexor levels and/or (b) decrease my social interaction. In addition, in the early hours of the morning, say, from 4 to 7 a.m. life‘s dark side would twist and turn like a worm and I had to make a fundamental distinction between the negative emotions and thoughts which arose due to my mental illness and those which arose from life itself—and most arose due to my BPD—but the intertwining made it difficult to separate the two sources: illness and life.
  • 86. 4.1.7.1 Intermittent explosive disorder or impulse control disorder, triggered by irritability, seemed to move into a much lower register as I turned into the first years of late adulthood(60-68). If I simply avoided situations that I knew would: (i) cause me to break-out, raise my voice beyond an appropriate register or behave in a violent way and (ii) result in behaviour that was an embarrassment to both me and others, I would be safe. By the middle years(65-75) of late adulthood, as some human development psychologists call the years from 60 to 80, I was much more aware of my limits and the dynamics involved, but I still got caught and had to reassess my interaction potential, ritual, capacity. Some psychologists place anger management as part of a simple subset of self-control issues. Self-control also includes: (a) skills like impulse control of all kinds, (b) the self-discipline to meet responsibilities, and (c) accepting delay of gratification when it's the best thing to do. 4.1.7.2 All of this is what emotional intelligence is about or at least that is one psychological domain in which to discuss these and related issues. Daniel Goleman's best seller Emotional Intelligence: Why It Can Matter More Than IQ made the term Emotional Intelligence(EI) widely popularized in the late 1990s. EI describes the ability, capacity, skill or, in the case of the trait EI model, a self-perceived ability, to identify, assess, and manage one‘s emotions, the emotions of others and of groups. Looking back over more than 60 years of periodic outbursts and varying intensities of inappropriate anger, say from 3 to 66, I can see an impulsivity and lack of emotional control as a key feature of my BPD. Self-management of my emotions is what I am after. I prefer this term to self-control. I don‘t want my behaviour to get negatively triggered and hijacked by my emotions. The process, though, seems to be lifelong, a slowly learned set of skills and understandings and on this new medication package, 2007-2012, yet another set of feelings to manage which I discuss later in this lengthy account. 4.1.7.2.1 See Wikipedia for an excellent overview of the concept of emotional intelligence, the abilities involved, the wide array of competencies and skills that drive leadership performance, the understanding of oneself and others, the relating well to people, the ability to adapt to and cope with the immediate surroundings in order to be more successful in dealing with environmental demands and the weaknesses of the concept and its application. 4.1.7.3 The following are two of my many internet posts in relation to the many forms of mental illness—and in this case anger. This post will say something about my internet work in the field of mental health. 4.1.7.3.1 I first posted at Anger Management, a sub-section of "Psychology forum home" at the internet site entitled uncommon knowledge--nearly four years ago in July 2006. The thread that developed from that initial post had some use to both me and others. This post, this thread that I am initiating here in the autumn of 2010 here in Australia, is somewhat of an update, at least for me, of that initial post here at uncommon knowledge some four years ago.-Ron Price, Tasmania. ELECTROPHYSIOLOGICAL RECORDINGS Since I retired from FT, PT and volunteer/casual work in the years 1999 to 2005, I have been thinking about the anger component of my bi-polar disorder(BPD). In these last six
  • 87. years, 2006 to 2012, the years of my full-retirement, I have come across various studies on the subject of anger which indicate that some 40 to 60 per cent of sufferers from BPD experience anger attacks. Sometimes the anger is seen in the context of a quite separate illness called "intermittent explosive disorder.‖ Sometimes, too, the anger of the sufferer from BPD is simply seen as related to, a part of, the BPD; sometimes the anger of the BPD sufferer is seen as just a normal part of his or her life. Most people experience anger in some way or another in their journey from cradle to grave. Indeed anger, in its controlled form, is quite a normal and appropriate emotion in life. My intention here is to make some analytical comments on anger and its several typical expressions in my life. I want in this prose-poem to provide an overview of its appearance over the last 69 years of my life-narrative. ―The man who gets angry at the right things,‖ wrote Aristotle, ―and with the right people, and in the right way and at the right time and for the right length of time, is commended.‖(1) I never really achieved this goal except: (a) indirectly through my writing, (b) partially in my daily life and (c) with the help of medications. The first time I remember getting angry, in an uncontrolled ‗over-the-top‘ sense, was just before my 20th birthday in the spring of 1964, just before finishing my first year of university. My mother‘s sister‘s son informed me when I was in my early sixties, though, that I had many a temper-tantrum in my early childhood. These tantrums seemed to die out by my middle childhood, the years 5 to 8, and I have no memory of these tantrums. The last time anger found a niche in my psyche was in 2013, more than a dozen years after retiring from full-time work. By then I was 68 and on an old-age pension. By my late fifties, I was able to mindfully dissolve my worst thoughts much more than I had ever been thanks to a new medication package. I was also able to successfully release the tiger of anger from its cage by buying a few precious seconds, recognizing the destructive potential of angry feelings as they emerged and bringing them down to manageable portions but, still, only most of the time. But a new medication package which began in 2007 saw an increase in the frequency of anger and fear. By 2010 it began to subside again, and the new meds regime begun in April 2012 looks promising for my anger issues. It has now been 50 years from the ostensible onset of BPD in 1963 to its latest treatment with a second, a third and a fourth medication package, fluvoxamine and sodium valproate, and now seroquel and effexor. If I include those early childhood temper tantrums which may, in fact, have been manifestations of BPD(but impossible to assess now after the passing of nearly 70 years) I could say I have had to deal with inappropriate anger for some seven decades. I now have a partial, indeed, a quite significant haven of peace. I can say with some pleasure and with a degree of contentment that I never had before: ―peace at last, peace at last, thank god-almighty, it‘s peace at last.‖ -Ron Price with thanks to (1) Aristotle, Nichomachean Ethics and My Autobiography: Pioneering Over Four Epochs, 31/3/'10 to 29/4/'13. Such a long, long story— life--punctuated as it is by slices of a bad dream on a stony-tortuous road, never felt like a message from the gods.....perhaps
  • 88. that was what anger was! A too-conscious memory now leaving in its wake unease, fears, anxieties, hopes, resource for poets and electrophysiological recordings in confusion.(1) Part of a cobweb, semblance of reality in the theatre of life, I am left now with feelings, pictures and meaning looking back in reflection over decades with gathered associations by that remarkable mechanism of the brain and that gentle and delightful tyrant, the memory which dominates sometimes softly and ethereally and also sometimes not-so-gently filling me with a mild terror, perhaps, until I exit from this mortal coil.(2) (1) Electrophysiology is the study of the electrical properties of biological cells and tissues. It involves measurements of voltage change or electric current on a wide variety of scales from single ion channel proteins to whole organs like the heart. In neuroscience, it includes measurements of the electrical activity of neurones, and particularly action potential activity. Recordings of large-scale electric signals from the nervous system such as electroencephalography, may also be referred to as electrophysiological recordings. (2) An excellent article on the subject of anger is entitled: Learning To Use Anger Constructively by Adam Blatner, M.D., an internet site by this name, 19 February, 2005. The article begins as follows: "Anger is a natural emotion and signals a need for a change in the environment. However, it is possible and usually desirable to express anger in modulated forms, and learning to do this is the hallmark of maturity.....It is useful to consider the range of situations that go with different levels of experiencing anger and discuss them fully with your partner--if you are one of those who are at least able to enter into such a dialogue. Many people, of course, are simply not able to discuss their inner life to any depth and so the sources of anger are never really dealt with.‖ Blatner then discusses 7 types of anger. 4.1.7.3.2 I also initiated another thread on a related issue of jealousy. Jealousy has not been one of the areas in life that has tested my psyche, although it did for several weeks in September just before I broke up from my first wife in late 1973. She had developed another relationship as had I with a member of the opposite sex. Hers was a relationship with a man whom she eventually married and to whom, nearly forty years later, she is still married. For those weeks in September, before we parted company and went our separate ways in early October 1973 anger and jealousy festered and they were a deadly
  • 89. combination. They have also been a deadly combination for millions of other couples. If not dealt with, they spell doom to most long-term relationships in our modern and post- modern age. My post at the internet site uncommon knowledge continued but this is the opening note. 4.1.8 Impulsivity can be thought of, described, in many ways. One negative way is to see it as a behaviour which seeks a small, short term gain at the expense of a large, long term loss. The essence of emotional self-regulation is the ability to delay the expression of impulses, to control one‘s emotions in the service of personal goals. Impulse control disorders are also considered to be part of the obsessive-compulsive disorder(OCD) spectrum, a spectrum I can easily identify as part of my life as I gaze retrospectively at my years all the way back to early childhood. OCD is a mental disorder most commonly characterized by intrusive, recurrent thoughts and obsessions resulting in repetitive compulsive behaviours and mental acts that the person feels driven to perform to reduce a distress that is associated with these obsessions. OCD is a debilitating chronic psychiatric illness with a lifetime prevalence of 2–3% of the worldwide population. 4.1.8.1 In my case, my OCD is not excessively debilitating and, if chronic, it does not result in troublesome behavioural problems in my daily life. I see my OCD as a disorder that exists in a mild form as does my psychiatrist who goes so far as to say I do not even have OCD. OCD is a disease that has apparently exploded in prevalence in recent decades. I also suffer from Obsessive Compulsive Personality Disorder(OCPD) which I have discussed above in 1.11.1, 1.11.3 and 3.5.2 and which I discuss again in 9.2.4.1 and which needs to be seen in the context of OCD. 4.1.9 The medical literature indicates that people who suffer from BPD experience ‗intermittent explosive disorder.‘ This lack of control, this uncontrolled form of anger, is said to be a biologically driven symptom of hypomania or mania, at least the relevant literature strongly suggests that this is so. My sexual urges, I might add, still remained, but they were less intense on the medication I began taking in April 2012 and even less after taking meds for my prostate problem. The interplay between two competing systems in the brain: the excitatory system and the inhibitory system which create, as one writer put it, an arousal template. As individual as a fingerprint, an arousal template is the total constellation of thoughts, images, behaviours, sounds, smells, sights fantasies and objects that arouse us sexually or arouse us in some other emotional way: visually, auditorily, inter alia. For me, these competing systems still competed into my sixties and had been competing virtually as long as I can remember. This framework of analysis based on an arousal template could be discussed in fine detail, but this is not the focus of my analysis of my BPD and its experience. It is, rather, a side issue, however pervasive an issue and however influential this issue has been in my life trajectory. The word ―explosive‖ was an appropriate one to associate with my anger episodes from the age of 18 until the age of 65 and with those temper tantrums I mentioned earlier in this account. But a mild anger, a more controlled anger, was a much more appropriate term than ‗explosive‘ for this new emotional register after the age of 60. Once the new medication package of NAVAL and effexor was routinized and stabilized, by February 2009, any angry tendencies were ‗seriously controlled,‘ although not entirely removed. If pushed, I could break out, so to speak. In the more than two years from February 2008 to January 2011, I broke out five times, getting angry at friends on four occasions, one very intensely making me decide to go back on my medication and kicking a dog twice, a dog
  • 90. which had bit my toes three times. I still had some work to do on that tiger in my tank! 4.1.10 My sexual proclivities and their manifestations over these same 60 years of memories are themselves a separate story. With 90% of marriages, where one partner is bi-polar, ending in divorce and a rate of suicide twenty times higher than in a normal population, I feel lucky to have survived and to have lived to tell my story. To be in the same marital relationship that I entered in 1975, thirty-five years ago, is also somewhat of a miracle. Perhaps I will go into the sexual, marital and suicidal/death-wish aspects of my BPD life in more detail at a later date, in a later edition of this document. These aspects of my account might spice-up this account, an account that for some I‘m sure is a somewhat tedious story, a boring, a too extended description and analysis. 4.1.10.1 ―Every passion borders on the chaotic,‖ wrote Walter Benjamin, ―but the collector‘s passion borders on the chaos of memories.‖ And this account is a collection, a chaos, of memories. It is a collection that is grounded in the interplay of material culture and memory studies and the recuperative veneration of the study of the everyday, the quotidian, as well as the study of my life in extremis . I could also recommend a number of books but I leave this to readers. Sarah Freeman provides an excellent minimal bibliography and I will mention one book here: Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, Second Edition by Frederick K. Goodwin, M.D., and Kay Redfield Jamison, Ph.D., Oxford University Press, NY, 2007, 1,288 pages. 4.1.10.2 I would also recommend Allan V. Horowitz's book "Creating Mental Illness" as excellent reading. He argues that the current conceptions of mental illness as a disease fit only a small number of serious psychological conditions. Most conditions currently regarded as mental illnesses are cultural constructions, normal reactions to stressful social circumstances, or simply forms of deviant behavior. He defined Mental Disease as conditions where symptoms include underlying internal dysfunctions. These are, he says, distinct from other disease conditions, and have certain universal features. Whatever conditions a particular social group defines as mental illness becomes M.I. This is, he argues, an actual labelling processes in any group and so cannot be true or false. In his analysis, he demonstrates how the medical models and social models of 'mental disorders' each have flaws to be addressed. 5. 2002-2010: ―Sodium Valproate Arrives in 2007‖ 5.1 In April 2007 I switched from the mood stabilizer lithium to sodium valproate. It became my main medication due to the fact that the creatinine levels in my blood, tested every 3 months for the previous six years and periodically and irregularly every year for 21 years before that, had been too high for too long—for about a year. These creatinine levels were indicators that readers of this document can read about in the BPD literature to see just how the kidney function can be affected by lithium treatment. I am not a doctor and I make no attempt to go into the finer aspects, the more detailed physiological aspects of this medical problem, this mental health illness. I have lived with it for years, but much of BPD as an illness is still beyond my level of analysis and the sophistication of my understanding—and it will remain so. My interest in the medical and scientific aspects of BPD, in spite of appearances to the contrary, are limited. 5.1.1 After all these years, my interest in fine-tuning my understanding, in enlarging my scientific knowledge of this disorder, is of a low order on my general scale of interests
  • 91. inspite, as I say, of any appearance to the contrary--as the evidence of writing this lengthy essay might indicate. Readers with a keen interest in the anatomical, the chemical and many physiological aspects of BPD can now read and study virtually any aspect of BPD on the internet if they have: (a) the computer skills and (b) the reading ability/level of competence. 5.1.2 There are to date no objective clinical laboratory blood tests for mood disorders. The current reliance on patient self-reporting of symptom severity and on the clinicians' impression is a rate-limiting step in effective treatment and new drug development. Some recent studies involving genome-wide linkage analysis of mood and psychotic disorders have raised the possibility that there is a common gene for susceptibility to BPD and other psychiatric disorders and that is may lie in a specific chromosome region. This statement of mine does not examine developments in either genetic studies or other objective blood tests for the treatment of BPD. There are now many studies indicating novel insights into the genetic causalities of many major psychiatric disorders as well as into the aetiology of such disorders. To even summarize them here would lead to prolixity. One good example of studies in genetic causality is a study which may suggest that there are common and population-specific susceptibility genes for bipolar I disorder. (Molecular Psychiatry (2011) 16, pp. 548–556; published online 13 April 2010) 5.2 Most of the people who ever read this document will not themselves be more than a little familiar with the relevant literature that relates to my problem, to BPD, although many may have a more than lingering interest in the disorder. Many readers here may have an interest in one or more of the many alternative medical treatments hypothesized by: (a) various health professionals and/or (b) the anti-psychiatry elements in society. Some specialized facilities, clinics and therapeutic centres under a variety of names, whose aims are to help BPD sufferers, combine a medical and an educational approach. Medicines and nutrients are often prescribed by physicians. To complement medical treatment, such programs often emphasize a wholesome diet, daily exercise and the development of habits that will assist recovery and support continued good health. Because of the strong learning orientation in such facilities, residents are often referred to as students rather than patients. 5.2.1 Jurriaan Plesman, a Nutritional Psychotherapist and author of Getting Off the Hook, offers his book free on the internet. For more articles see the free web site at: Hypoglycemic Health Association of Australia. 5.2.2 The staff in such specialized clinics often includes professionals with credentials in psychology, psychotherapy, social work, substance abuse counselling and biochemistry as well as teachers of nutrition, exercise, arts, crafts, dance, drama, writing, and literature. Orthomolecular physicians are often at the core of these alternative medicine homes, clinics or residential care places and they supervise the medical treatment of the students. A visiting nurse, a behavioural optometrist, a chiropractor and an acupuncturist are often and also available. 5.2.3 Among the many alternative and coextensive therapies for BPD are: (a) the Da Vinci Method outlined in a book by Garret Loporto. Those with BPD, so argues Loporto, need to learn how to evoke and manage the passion that elicits their hyperfocus, their energy and creativity. The BPD gene affects the brain's relationship
  • 92. with dopamine. This difference causes the person with BPD to: (i) crave stimulation just to feel alive and (ii) have unstable moods. Loporto does not offer a method nor does he offer a way to deal with the depression side of BPD. Readers of this book who suffer from BPD need to go elsewhere to help them deal with depression; (b) cognitive behavioural therapy which helps people change inappropriate or negative thought patterns associated with the disease; (c) psychoeducation which teaches patients about the illness and to recognize signs of recurrence; (d) family therapy helps family members to help deal with the condition; (e) interpersonal and social rhythm therapy which helps a patient with the condition deal with relationships and standardize routines and sleep behaviour in an effort to prevent manic episodes and avoid incapacitating depressive reactions; (f) exposure therapy for complex anxiety disorders as well as BPD and (g) vagus nerve stimulation(VNS) in which electric pulsing completely quashes the symptoms of depression. VNS was approved as a depression therapy for use in conjunction with drugs, by government regulators in the European Union and Canada in 2001. In June 2009 it became the first psychiatric device to be reviewed and approved in the United States which has more stringent requirements for medical devices. Other "wearable" devices are being tested and developed by other companies that involve transcutaneous stimulation and do not require surgery. 5.2.4 A little known, but potentially life-saving, fact is that common medications deplete vital nutrients essential to one‘s health. For every dollar our society spends on prescription drugs, our society also spends a dollar to fix a complication. Understanding how nutritional supplements affect these drugs could make them safer and more effective. My wife and I, and especially my wife, give great attention to this reality and she tries to provide an excellent diet. The author I refer to here in this footnote provides a practical guide to avoid drug-induced nutrient depletion, and even replace your medications with natural supplements. I only want to refer to this topic here and, although I take natural supplements, I do not intend to replace my medications with them. Relative cost-benefit and efficacy studies comparing drug treatment to therapy are abundant. Pharmaceutical treatment is still the only option that provides quick and inexpensive care for problems like BPD with complex etiologies. 5.2.4.1 By the time I came to write the 12th edition of this ongoing story of BPD, I was taking fish oil, vitamin D, calcium, vitamin C, aspirin and zinc. Dealing with BPD has involved an ongoing concern for all sorts of aspects of life; having BPD sensitized me to many aspects of living I would not otherwise have paid the attention I have. On 26/5/'12, for example, I added magnesium to this package of nutritional and medical supplements. I added it for the following reason: Magnesium is a mineral that helps maintain normal muscle and nerve function, keep heart rhythm steady, support a healthy immune system and keep bones strong. Some indications of deficiency of magnesium are: muscle tremors or spasm, muscle weakness,
  • 93. insomnia or nervousness, high blood pressure, irregular heartbeat, constipation, fits or convulsions, hyperactivity, depression, confusion and lack of appetite. Magnesium is interesting in bipolar disorder because of its chemical similarity to lithium (lithium being the drug most commonly used as a mood stabiliser). In fact, there is some evidence that the drug lithium may attach to the places inside the cell where magnesium is supposed to attach. In studies (Chouinard, Giannini), some people with bipolar disorder or other psychiatric illnesses had differences in the amounts of magnesium in their blood. There have been some studies where magnesium was added to other treatments to stop symptoms of mania or rapid cycling. Magnesium can block the entry of too much calcium into cells (it is a natural calcium channel blocker) which may explain why it is helpful with some symptoms of illnesses. Magnesium‘s role in supporting good sleep may also be quite important here, since many people with bipolar disorder experience increasingly poor sleep patterns preceding a manic episode. 5.3 One of the typical responses to my ‗coming out‘ as a person with BPD in recent years is an urging that I seek out some alternative medicine milieu. In the past I have often entered into some ensuing dialogue with my friends, family and associations, my listeners and readers, students and laymen: in letter, over the phone, in conversation and now in email form or on the internet—a dialogue about the use of some other treatment than drug therapy. But this statement, this essay, does not explore these alternatives, the ones I have investigated and not investigated, nor does it examine the details of the biological and physiological, medical and anatomical aspects of BPD. 5.3.1 After all these years I have lost any desire to try alternative/other treatment regimens/packages and now rely solely on: (i) my psychiatrist who is available for a consultation after a single phone-call and within the month, (ii) my medications which I am happy with and have no desire to change and (iii) my wife to whom I have been married for 36 years and who has the best understanding of me than anyone--to provide the core milieu for my current and prospective treatment regime. I take a general and somewhat detached interest in alternatives as they appear in the literature but, for the most part, I do not take them seriously as alternatives for my own path, for my own prescription for living. This is partly due to: (a) my lack of funds, (b) partly due to the fact that well-staffed alternative facilities with sophisticated treatment packages/process do not exist anywhere near where I live in Australia, but it is mainly due to (c) the fact that I am happy with my current treatment regime. 5.4 I leave the investigation of alternatives, of the finer aspects of the physiological and medical aspects of BPD and indeed the burgeoning literature on the subject to the keener students and readers here. I have been encouraged, found the courage, at least initially, in my coming-out due to several celebrities in the media who, since the 1990s, have made their BPD public. Stigmatization still exists, although it is not as strong as it was, say, nearly two decades ago in 1992 when I was stabilized on lithium and totally complaint, when I was working in professional employment, when I was active in local community life and, for the most part, kept my story under wraps, except on rare and exceptional occasions of ‗coming- out.‘ 5.5 If I were a Hollywood actor in the last twenty-five years (1985-2011), to say nothing of films in the last fifty(1960-2011), I would be calling my agent to be on the lookout for roles in which I could play a mentally troubled character. Dustin Hoffman in the 1988 film Rain Man won an Academy Award for Best Actor in a Leading Role for his
  • 94. portrayal of a man with autism; Kathy Bates earned her Oscar playing a madwoman in Misery in 1990; the next year, Anthony Hopkins earned one for the role of a cannibal, Hannibal Lecter; in 1993 Holly Hunter was the mute heroine of The Piano; 1994 produced Tom Hanks as the strange-mentally challenged but winning Forrest Gump; in 1995 there was the alcoholic Nicholas Cage of Leaving Las Vegas; Geoffrey Rush won the Best Actor award for his 1996 performance as schizoaffective pianist David Helfgott; 1997 was Jack Nicholson's turn for doing obsessive compulsive disorder; James Coburn picked up his Oscar as the sadistic paranoid father in 1998's Affliction; and in 1999, Michael Caine was a narcotics addict and Angelina Jolie co-starred as the sociopath of Girl, Interrupted. All of the following films featured BPD: Mr. Jones (1993), Pollock (2001), Sylvia (2003), Mad Love (1995), The Horse Whisperer (1998) and Michael Clayton(2007). 5.5.1 Overall, the mass media do a poor job of depicting mental illness, with misinformation frequently communicated, unfavourable stereotypes of people with mental illnesses predominating, and psychiatric terms used in inaccurate and offensive ways." The list of activities performed by people and various organizations dedicated to struggle against stigma is not only impressively long and wide-ranging, but provokes strong inspiration as well. I hope this extended personal account is seen by those who comes across it as part of that struggle against stigma. 5.5.1.1 Legislation and policy in mental health, disability, anti-discrimination and education now espouse principles of fair and equitable treatment for people experiencing mental health difficulties. In practice however, a major barrier to the enactment of these principles is non-disclosure of mental health difficulties by people due to fears of discrimination. Stigma is still a major obstacle preventing people from disclosing mental health difficulties and receiving appropriate assistance. The future for people experiencing mental health difficulties in social work and welfare studies is more hopeful than ever before. Further research, in particular, substantial comparative case studies, that include a brief mental health screening tool and demographic data, will result in the generation of transferable knowledge about the problems that people have who deal with BPD. 5.5.2 The year 1981 was proclaimed the International Year of Disabled Persons (IYDP) by the United Nations. It called for a plan of action with an emphasis on equalization of opportunities, rehabilitation and prevention of disabilities. The theme of IYDP was "full participation and equality", defined as the right of persons with disabilities to take part fully in the life and development of their societies, enjoy living conditions equal to those of other citizens, and have an equal share in improved conditions resulting from socio- economic development. By 2008 there were 3,900 athletes from 146 countries in Beijing at the paralympics. Although this extended discussion of the disabled portrayed in films and the disabled in sport is tangential to my BPD story, it is relevant to mention, en passant. 5.5.3 The illness I had suffered from, starting perhaps at my conception in 1943, had become, in some ways, a source of claim to fame. But it was not all a story of a new age of understanding. On television, that most popular story-teller in modern society, people negotiated their attitudes to and their understandings of different social and political issues of which mental illness/distress was but one. The most common disability portrayed on television during the years that this autobiography was being written, 1984-
  • 95. 2013, has been mental illness/distress. We find the following mental problems portrayed: agoraphobia, BPD, autism, OCD, personality disorders, amnesia, various anxiety disorders and schizophrenia among others. People‘s information and knowledge of the subject comes, for the most part, from TV which often perpetuates the stigma and the negative stereotypes by inaccurate depictions, misinformation and uninformed dramatic sketches. This has been part of the world of the mentally ill for centuries and it has been part of the backdrop of my own experience in these several epochs. In some ways it is difficult to appreciate how far society has come in its knowledge and understanding; in other ways the problems are massive and complex. 5.5.4 This autobiography suggests, exemplifies, a psychological reality that opposes and withstands the plague of popular fantasies that bombard consciousness in these epochs. My identity is not merely an image, ultimately empty, a symbol of another's demand on my life in an image-conscious society. I accept that image has become a central aspect of life today; indeed to some extent I revel in it. I play the game, but realize it's a game. I know that many of my desires I have been taught through my only partly avoidable immersion in society's realities. I have been hooked, as we all have been in varying extents, by the "aesthetics of consumerism.‖ "Coolness" and "glamorousness" I am aware of in some symbolic world that I inhabit in a depthless realm of masks, of images and brand names whose cache and status inevitably change, revealing no stable core at best or no substance at all. 5.5.4.1 But I know my reality is not image. The movies I have seen are entertaining but have only what some writers call a secondary reality. Consequently, I am plunged into and forged by a sea of signifiers which, while stimulating my sensory emporium, ultimately signify something approaching nothing. I am conscious of body image but I get no sense of identity from my body. My psyche, to the extent that it is filled with electronic media products, is a void because that environment is an abyss, and the inner world, if one can call it that, which it recreates in this narration is just as depleted. This subject, which I have alluded to here only briefly, is a long and complex one and I shall leave it here. 5.6 The milieu of alternatives to mainstream pharmacology for my psychiatric disorder, my BPD, in 2011 is a different milieu-of- alternatives than was available in 1963 when I first had significant manifestations of this problem even though my BPD was not diagnosed as such until 1968; but this is a tangential topic or issue. As I indicated above, I no longer seriously consider alternative treatments since I am happy with my medication regime. But let me return to the new medication regime I began in 2007 and the kidney difficulty which led to these new medications. 5.7 Had I continued on lithium in 2001 I would have had serious health problems associated with kidney damage and eventually had to go on a dialysis machine. As I write this 12th edition of my story, I have been on the sodium valproate for 11 years. I have now found a new routine, a new normality, for my sleeping pattern, although it has not been as difficult as the regime change in Iraq has been for the USA. This change in sleeping routine has been difficult to establish. The process of establishing a new sleeping pattern has affected me much more than the nightly stories do on the TV and radio about that distant and war-torn country or, I might add, the many other crises, disasters and many community concerns both within and without the Bahá'í community I have been a member of for more than fifty years.
  • 96. 5.8 I always have a short sleep in the afternoon or early evening for one to two hours after I have been awake from my nightly sleep for about eight hours. Sometimes I go to sleep for an hour in the first 2 or 3 hours after waking, if I did not have a sound sleep the night before. Now after five years on this new cocktail of drugs and its fine tuning in the last three years (1/09-1/12), this new sleeping pattern has assumed a regularity, a new normality. BPD is associated with irregular or pathological functioning of circadian rhythms. The circadian rhythms are the regular rhythmic changes in waking and sleeping, waxing and waning activity levels, even sensations of hunger or thirst and their satisfaction. These rhythms become disordered when a person suffers from BPD. Sleeping and waking, as well as other patterns such as eating habits and activity levels, are disturbed. This internal clock is difficult to reset when a new cocktail of medication is administered. 5.8.1 After five years(5/07-4/12) this clock had been reset. But it needed resetting in the months after March 2012 since in April I went on a new meds pkg. Teenagers have problems with sleep patterns and there are now techniques available to help them regularize their patterns. I could use these same techniques for they are useful for sufferers of BPD. But I am happy now with my sleep patterns. For several months from August 2009 to January 2010 I took one panadol before going to bed to smooth out my sleep regime and it seems to have helped. But I discontinued the practice and the change seemed to have no effect on my sleeping experience. People tend to sleep more lightly and for shorter time spans as they get older. This is certainly the case with me, although I generally need about the same amount of total sleep as I needed in early adulthood— about 8 hours in every 24. I am currently sleeping an average of 8 hours every day and am in bed for an average of 11 hours. 5.9 Since I occupy the same bed and occupy, too, the same space, the same house, day after day, as my wife, routines and patterns are important. I like to maintain a regular sleeping pattern and sleep with my wife as much as possible. My interest in this important aspect of my life is not for the sake of sexual activity as some readers might be keen to read about and as I would only be too keen to read about as well--and thus provide, in the process, a sexual-spice in this account and in my personal and sexual proclivities. In March 2013 we began to have separate but contiguous beds so that my wife is not troubled by my restlessness at night. 5.10 I‘m sure by now some readers are finding the absence of some of the frequent absurdity of BPD behaviour, frequent stories of sexual and other behavioural abnormalities and/or any general eccentricities in my day to day life, which often characterizes BPD stories, is making this narrative far too clinical, indeed, overwhelmingly clinical and analytical for their liking. I go into the sexual aspects of my disorder to a greater extent in my memoirs or autobiography. I do have my eccentricities, as some of my friends and associations would/could easily point out. Perhaps I have more strange traits than most. But as one famous aphorism states: ―everyone is a bit strange, except me and thee—and even thee is strange.‖ This aphorism underlines one approach to this complex issue of human eccentricity and its various manifestations in community life. 5.11 Antidepressants have many side effects, one of which was decreased libido and this was true of the two antidepressants I took after 2001, luvox and effexor. But this was
  • 97. only marginally true. Finding the right combination of BPD medications to control a hypomania that tends toward mania has been a helpful step toward keeping my hypersexuality, if I can call it that, from becoming destructive. With the accelerated availability, publication and distribution of pornography in more accessible, anonymous and affordable forms on the internet and in the print and electronic media, it has become much easier for me to tap into my arousal template, easier than, say, it had been in the years since Playboy came on the market in 1953. 5.11.1 I should mention here the side effects of the effexor since it had become, with NAVAL, a key component of my meds by 2007. Diarrhoea, dizziness, heartburn, gas, unusual tiredness or weakness, abnormal dreams and anxiety, muscle tension, yawning-- -and, I should add, frequent urination due to 27 years on lithium. 5.11.2 The stimulation of my libido, my id, my libidinal urges continued, but virtually ceased, as I mentioned above several times. One can only avoid stimulation if one keeps entirely away from the print and electronic media. There are new difficulties in our society, in developed societies, resulting from the demands of a sexual morality utterly at variance with the massive sexual propaganda and its enhanced and erotic stimulation to which all consumer societies are subject. It is not my purpose to focus on this aspect of my life‘s behavioural trajectory here, but I would like to make a general comment in the next section 5.12, on the line between negative behaviours that genuinely derive from my BPD and those behaviours that are simply convenient to blame on BPD. 5.12 When faced with negative behaviours in the sexual, verbally aggressive, verbally immoderate domains or, indeed, any form of excessive behaviour, the question as to where one draws the line between: (a) what to blame on BPD or one of my other disorders and (b) what to blame on simple lack of self-control is a difficult and ongoing problem. Is there any way to clearly differentiate between these two possible explanations of my negative behaviours in these areas? Can I accept as valid an airy, dismissive "oh, I can't help myself, I'm bipolar" and yield to my instincts, drives and emotions? 5.12.1 Psychological problems and disorders like BPD, OCD, OCPD and PTSD as they are defined in the DSM-IV, constitute the only nosology, that is the only medical categorization system, without clear aetiologies, that is without clear neurological causation. Research in neuroscience is gradually moving toward the point where some of the aetiology/causation as well as the lines of differentiation, are becoming more apparent. However, for the time being, there does not seem to be any way to state definitively one way or the other. 5.12.2 I thank Mark Foster for his post on this theme at bahá‘í-mental-health @yahoogroups.com, 12 July 2008. In addition, I want to emphasize here that developments in the basic neurosciences will hopefully be translated in the years immediately ahead into more efficacious diagnostic, preventive, and therapeutic interventions. There is an urgent need to transform basic research discoveries into tools for the treatment and prevention of mental health difficulties. Efforts to stimulate the translation of basic and clinical neuroscience findings into novel targets, models, compounds and strategies for the development of innovative therapeutics for psychiatric disorders are bringing results but often more slowly than surely. I could highlight here some examples of collaborations and partnerships among medical research, academia,
  • 98. and industry, but that is beyond the focus of this account. 5.13 I should add here, somewhat parenthetically but still importantly, that there are many who might be, and often are, called mental illness/distress conservatives. Such "conservatives‖ don't believe in mental illness/distress. Rather, they believe patients make a conscious choice to be mentally ill, just the same as others choose to be gay, and some choose to be drug addicts, among other addictions and disorders. The term mental health service users is often preferred to the term patients. While I think there is some truth in this remark, I would not want to push this view too far and apply its results in terms of a treatment that would result in all circumstances. This position is an extreme one from my perspective, too extreme for my liking and in my experience. It is a position, though, that would/could sometimes help BPD sufferers. It is one I held myself for a decade(1969-1979-circa) when I refused to take medication and tried alternatives which I have discussed elsewhere in this statement. There are also the anti-psychiatry people and they are in a similar basket to the conservatives. 5.14 This conservative position, this form of advice, though, could be more than unwise. It could be criminal. In my case I have come to see my treatment regime in terms of getting the right medication balance and now that I am 67 and on two old age pensions I hope I have at last found this balance. Time, of course, will tell. Even if I assume I have the right balance in medication, there is still the problem of behaviour and this problem in its many forms is far from solved. 5.14.1 I could expatiate on this theme since my espousal of this conservative position was, in the end, not a wise one. There were times when my behaviour was sufficiently ‗normal‘ as not to require meds, but there were times when there was no substitute and, indeed, until modern pharmacology, there was no substitute no substitute for the extreme aberrations of behaviour of BPD sufferers. Many self-medicate with alcohol for the depressive side of BPD or cocaine to obtain the stimulating side of BPD--among other drugs. This was never one of my ways of dealing with mood swings. 5.15 In all this discussion, however, it is important for me that, however much science can quantify neurotransmitters, nerve pathways, cellular processes, complex amino acid structures and brain chemistry, it cannot weigh or dissect a mind. Some modern writers use the word ‗mind‘ because they don't want to use the word soul or they consider the mind as a property of the soul. Many scientists loosely use the word ‗nature,‘ that is the mechanisms of the physical universe, where others might be inclined to say ‗creation‘ of which nature is just the evanescent part. These philosophico-psychologico-religious issues I do not deal with in this document. However interesting these issues may be to some readers, they are tangential to the central focus I try to maintain throughout this statement—and I therefore do not deal with them in any detail. 5.16 Routines are important when living with others, as I mentioned above, in different ways than when living alone. Much must be done for the sake of a more harmonious and general interaction due to the interdependence and interrelationship that exists. In May- June 2007 when first going on this new medication package my sleeping patterns varied from 2 to 4 hours per night. They gradually became a regular eight to nine hours with a waking and getting up two or three times for urination. Included in those 8 hours is a sleep for 1 to 2 hours in the day/evening: (a) to make up for the loss of sleep at night, (b) to give into a tired feeling or (c) due to my new circadian rhythm.
  • 99. 5.17 My wife has helped me in this area of sleep-monitoring, although she came to find it frustrating, the endless discussion of sleep and its patterns. I should add, somewhat parenthetically but very importantly, that since the late 1970s when the first episodes of this disorder appeared during this my second marriage, my second wife has been my main care-giver. I have been her main caregiver, but that is a separate story which I briefly refer to below. We have each been for each other the main care-givers over these many years. We have not, though, applied for care-giver status and its remunerative package from Centrelink a sector of the Human Services Department here in Australia for reasons explained above. 5.18 My preference and need for sleep seems to be from 8 to 9 hours on average per day. This is slightly more than has been the case since the early onset of this disorder back in the 1960s, although in my teens and twenties, as in my childhood before, sleeping patterns have had great variations. The whole question and story of sleeping patterns is a long and complex one and I don‘t want to go into any more detail on this theme than I already have; indeed, concern for and obsession with sleep is a characteristic worry of many of those who suffer from BPD and over the years I have often written pages of analysis and gathered pages of data on my sleeping patterns, but I will limit my discussion of this subject in my life at this juncture in this essay. 5.18.1 My relationship with my wife has not always been a smooth one and neither was my first marriage. In both marriages, though, my wife has been a great help to me. In the case of my first wife she visited me in the hospital daily from her home in Toronto to the hospital in Whitby during my first major BPD episode that last several months. My second wife has lived with my inevitable ups and downs for nearly 40 years(1974 to 2013). I have had ups-and-downs both inside and outside of marriage and I have alluded to them in my memoirs. I do not go into detail on these personal ups-and-downs in this account. There are a host of behaviours and activities in my life that were affected by my BPD but, in the main, my focus in this account is on the BPD itself and my efforts to treat it, to deal with it and not the myriad manifestations of problems and behaviours that resulted decade after decade, year after year. 5.18.2 One such area I could expand on, for example, is found in a behaviour or tendency toward a type of borderline personality disorder(BoPD). This behaviour is typified by: (a) a marked unsteadiness or instability, and (b) a reactivity of mood, sometimes called emotional dysregulation. This emotional dysregulation is the response to external psychosocial and intrapsychic stressors. This sense of unsteadiness, instability or emotional irregularity may arise or subside suddenly and dramatically within a few minutes and last for seconds, minutes, hours or days. In my case the psychosocial stressor has often been some criticism of my behaviour. The phenomenon is complex and difficult to deal with here in a few words, but the intensity of negative feeling that is aroused is out of all proportion to the critical remark made. 5.18.2.1 Flux is part of the fundamental nature of BPD. The terms raging and swinging as well as mixed and emotionally-episodic are, for me, words that characterize and describe my experience of BPD over the years—not 24/7, as they say, but certainly periodically. There are several typologies of BPD from two to five. I do not want to go into the detail that describes the types, but an awareness of these sub-types can help individuals with BPD who want to understand its several manifestations. Individuals
  • 100. with BPD often have periods with many changes in energy, mood, thought, sleep and activity. 6. April 2007 To April 2012 : Enter Venlafaxine 6.1 I have a solid base of experience now with venlafaxine or effexor as it is known commercially. After five years on this new medication(4/07-4/12), combined as it is with sodium valproate, the future on this medication package looks promising. A new sense of normality, of my old self, in an ironic sort of way, had already returned in the first two months(4/07-6/07) of my being on the final element of this new medication-cocktail, venlafaxine. The symptoms of my OCD have significantly dissipated, although they are still present in an abnormal way from my wife‘s point of view. This notion, though, of ―my old self‖ only lasts for two hours of so and I begin to tire quickly and often need to go to bed and either rest or sleep. 6.1.1 My wife is the person who observes me more than anyone and her opinion is important in making this statement and in forming the view of myself that I hold at any one time. This might be called ‗the social construction of reality‘ as some sociologists call this way we come to view ourselves. 6.2 I can feel what I often describe as ‗the healing effects‘ of this medication package. My wife calls this healing effect a sense of well-being and she sees it as characterized essentially by less frenetic activity. It looks like I am going to win the battle with BPD, although I had my doubts even as recently as April 2007. I must accept, though, the decline in my social functioning and my need for 2 hours of sleep during the day. 6.2.1 In the past the battle has periodically looked like a situation of utter defeat, a sense of defeat I first experienced as far back as those October evenings in 1962 when I first suffered a blackness I had never felt before. I had, at that time, no idea what was happening to me. Frenetic activity is still present and my wife could give a running commentary on this aspect of my behaviour even now after four years on this new medication package. When I say I am winning the battle with BPD, readers should not read into this statement that (i) I never get despondent or (ii) don‘t experience very negative feelings. These feelings enter my being, as I‘ve said on occasion in thi lengthy account only before going to bed. 6.3 The effects of BPD on my day to day life seem to have been finally put into a reasonably comfortable niche so that I can go on with the next chapter of my life. The negative effects may rear their ugly heads, yet again at some future time but, for now, I can put this account to bed. I have to thank my psychiatrist for his skills and expertise and the medications and consultations that are part of modern psychopharmacology and psychiatry for this progress—in the main. The profound advances in bio-medical knowledge and research so rapidly accruing today, although not being effectively transformed into meaningful advances in health care for literally billions of people in our global society, are being brought to my attention and applied to my BPD, as they are to other billions on this earth. The worse that can be said about the skills of my penultimate psychiatrist is that at more than 70 years of age he offers to me a more traditional pharmacological approach and he is not likely to experiment with: (a) other medications for BPD or (b) alternative treatments as younger/other psychiatrists might do.
  • 101. 6.4 When I say that I can put this account to bed I do not mean to imply that my personal response patterns in day-to-day life do not involve imbalances, immaturities and imperfections, as I have indicated above. I am often unaware of these patterns even after these many years of living and dealing with BPD. My wife helps to keep me conscious of my behavioural failings in these areas. I am often simply unaware of both my external behaviours and the internal messages, the triggers, what might be called the inner psychic mechanisms and the automatic external responses that result from these patterns. 6.4.1 I am aware that tracking, exploring and processing this inner world, what is sometimes called mindfulness, can be very beneficial to my therapeutic progress. The little knowledge I have gained, thusfar, over several decades, about these patterns and processes has given me a pathway to being proactive and it has helped me create a better life. It is also an ongoing process that may quite probably never end. Taking charge of one's life, which this account is attempting to put into words, involves risk because it means confronting a diversity of open possibilities. My present BPD situation is not set in cement. 6.5 Taking stock of my strengths and weaknesses and making deliberate efforts to bring my behaviour patterns into harmony, balance and full development is a lifelong journey. Some encounters in life demand what we are equal to, what our nerves can handle. Over the course of a life-time, though, we experience many encounters which we are far from equal-to, which are simply beyond our capacity to handle. We can call this experience life‘s tests and some of these tests we fail; some relationships are lost; they end due to our own behaviour; some verbal exchanges are far, far from adequate to the situation. This is only saying the obvious. 6.5.1 My will often seems to be drained; at the age of 69 I often feel as if I am starting all over again. Sometimes I feel like giving up. Is there any point of fighting a battle I am going to lose? Accepting what I cannot change, changing the things I can and having the wisdom to know the difference, as they say in AA, still keeps me busy in life. I often feel like I am or I have become a burnt-out case. I yearn for release from this earthly life. I have often been a burnt-out case in the past and even now, as I write the 13th edition of my BPD story, I am only too aware that, although the in extremis aspects of my life are being contained for the most part, my BPD story is far from over. 7. Other Difficulties: 7.1 The Physical and Psychosocial: 7.1.1 In 2002 I was diagnosed with chronic obstructive pulmonary disease(COPD) or emphysema which gives me a shortage of breath when I exert myself even mildly. Several million people die globally from this illness each year and by 2030 COPD will be the 4th leading cause of death worldwide. There are a range of bleak statistics, but it is not my intention of discussing this medical problem in any detail, only insofar as it relates to my BPD. My form of COPD is mild as was indicated on a spirometer test for COPD, a test I took in 2002. My COPD probably originated in: (i) my smoking an average of one package of cigarettes every day from the age of 20 to 50, 1963/4 to 1993/4, (ii) growing-up in a household where both parents smoked and (iii) working in an environment in which others smoked for 30 years(1963-1993). The onset of this tobacco habit coincided, coincidentally, with the clear onset of my BPD symptoms,
  • 102. 1963. I did suffer from a mild RSI and various other maladies in addition to COPD, some of which I treated with exercise, thus lessening their overall effects. These several medical problems exacerbated my remaining BPD symptoms and I have outlined them in appendix #4 below. 7.1.2 In the last dozen years 2001 to 2013 it has become by degrees more difficult for me to engage in any physical activity for more than short periods of time in excess of: (i) a few minutes of domestic work like vacuuming, or (ii) half an hour of walking. I was informed by my GP in 2002, and I have read in the relevant literature that with regular/daily aerobic exercise this few minutes could be increased. My Chronic Obstructive Pulmonary Disease(COPD) or emphysema can be improved in the process, although it can not be eliminated. By 2012 I was swimming on average once a month for an hour in a local indoor swimming pool and found I did not tire as quickly as when walking, running, or doing domestic work. Carotid artery wall thickening increases in older COPD patients compared with control patients with normal lung function, so a 2012 study found. The carotid artery is the large artery in the neck that carries blood to the brain. COPD was an independent predictor of the presence of plaques with a lipid core and the carotid artery in COPD patients is more prone to rupture. Patients with this progressive lung condition, COPD, are more likely to have vulnerable fatty plaques which increase their risk for stroke. This was a statement of the researchers, Dr. Bruno Stricker, professor of pharmaco-epidemiology at the Erasmus Medical Center in Rotterdam, the Netherlands. 7.1.2.1 In the case of social interaction for more than about two hours, I now find that I can only take part in stimulation of this type for 2 hours or less without my level of social efficiency decreasing, my social interaction skills degenerating and fatigue setting in. I have also kept a database(see appendix #4 below) of information on: (a) my visits to GPs and psychiatrists since 1999 with an outline of the several medical problems and treatment regimes in the many aspects of my health as well as (b) aspects of my health since 1980 when I went on lithium, like weight gain(70 pounds from 1980 to 2012), but it is not my intention to discuss any of all of these problems here--only to the limited extent that there is a direct relationship with my BPD, as is the case with COPD. 7.1.3 These two activities, the physical and the social, if taken in excess of the time limits I have indicated above and if necessity has requried that I do, it imposes a strain on either my physical or social capacities and sensibilities. I‘m not sure how much of the above is related to the BPD and how much is just the natural result of moving into the middle years(65-75) of late adulthood(60-80) in 2009. With fifty years of a working life also behind me, 1955 to 2005; with PT and most volunteer work also behind me by 2005; with no desire to take part in most of casual and voluntary work‘s many forms anymore; with decades of struggling with various features of SAD, P, D, MD and BPD and the occasional episode I have described briefly above, I feel as if the years from, say, 1955 to 2005, a half century, have slowly and insensibly removed many of life‘s juices from my being. 7.1.3.1 These years I refer to above did not remove all my juices, though, thankfully. I enjoy reading and writing, eating and drinking, socialising to a minimum and watching a little TV-about one hour each day on average. The ravages of my disorder, if I carefully manage and monitor my activity as I have already indicated, are not experienced. On
  • 103. average, say, since my early retirement in 1999, I lose control and get angry once a year. From the age of 55 to 69, this over-the-topness has decreased to, perhaps, once every 18 months. But the tiger of anger is still something I must watch, as I have for the 50 years: 1963 to 2013, the age of 19 to 69. I need to push the envelope of exercise more than I have done in the dozen years since I retired(2000 to 2012) in order to simply maintain better all-round health. The effects of my medication regime and my enthusiasm to write and read tend to deplete both my energy and my desire to be physically active, but there has been a slow and incremental improvement in these retirement years. 7.1.4 For the most part in community life I rarely talk about my BPD and most people who know me have no idea of my medical history, or the difficulties that I have lived under physically or psycho-socially. Most people have a domain of private experience which they keep to themselves for the most part and so this is not of itself unusual. We often, if not usually, have little idea of the inner battles that others go through in life. I have for many years regarded my difficulties as part of my own spiritual battles in life. They are difficulties that have largely slipped into a low gear in the last several years, since being stabilized on my recent medication package. These symptoms do not trouble me significantly except in the ways I have indicated in the above paragraphs. As I say, this seems especially the case with the two medication packages I have been on in the last five-and-one-half years(5/07 to 11/12). 7.1.5 I should mention that a certain spiritual attitude which has been part of my belief system since the 1950s has helped me more than I can myself really appreciate. This is especially true of the attitude to tests and difficulties in life which the Founder of my religion, Baha‘u‘llah, says are often ―like fire and vengeance but inwardly light and mercy;‖ or as the old English proverb puts it more colloquially: ―the gem cannot be polished without friction.‖ An attitude of fighting one‘s own spiritual battles without giving vent to them verbally, an attitude of suffering in silence, or what in Australia is often called the quiet battler mentality, has also been part of my way of looking at life. And it still is. I could express my psychological approach in Adlerian terms and especially the terms described in Erik Blumenthal‘s The Way to Inner Freedom, One World Publishing, London, 1988. I do not intend to outline the philosophical or sociological bases of my approach to this disorder in particular or to life in general 7.1.5.1 Bahá‘u‘lláh is the Prophet-Founder of the Baha‘i Faith. There is so much I could say about my religion and its relationship to my experience of BPD but, like other possible tangents to the central theme here, I do not give it any more emphasis than a host of other possible tangents to the main storyline. 7.1.6 But even the wisest of advice, the finest of philosophy and the most practical of alternative and specialized treatments does not and will not remove all of our suffering, mine or humanity‘s. Indeed, it is my view that suffering may just be part of the critical axis of our life, mine, others and society‘s. If one can eliminate some of the suffering in one‘s life it seems to me only natural to do so and this account is the story of the elimination of some, if not most, of that suffering, at least as it relates to BPD. But however one views suffering, it comes to us all. This account does not deal, as I say, with the philosophical and largely religious aspects of my struggle with BPD nor the wider psycho-social aspects of my tests and difficulties except in a few broad strokes.
  • 104. 7.2 Application of the Recovery Model: 7.2.1 In the last decade or two, perhaps as far back as four decades to the 1970s, there has developed in psychiatry and psychology what has been variously termed a self- regulatory, self-diagnostic, illness-identity-and-monitoring model aimed at one‘s personal ongoing treatment, care and recovery. It is a program that involves the client, much more than programs of treatment ever did before, in developing and drawing on what are sometimes called the evidence-based skills of mental health consumers. These skills are applied to and in a manner consistent with, the particular disorder. The consumer, the client, becomes their own doctor but this, as one can appreciate, is no easy achievement and the literature on the subject is extensive. 7.2.1.1 Using Ivan Goldberg‘s Goldberg Bipolar Screening Quiz I scored 36 to 50 which is on ―the moderate to severe symptoms‖ part of the scale. 7.2.2 It is argued that this Recovery Model is based on: (a) the evidence-based skills of mental health consumers; and (b) the provision of an integrative framework combining both a description and analysis of: (i) the evidence-based practice of these consumers and, in my case, the practice and skills of certain significant others in my life; (ii) manageable and modularized competencies relevant to case management and psychosocial rehabilitation contexts; and (iii) a greater recognition of the subjective experiences of consumers. The importance of one‘s GP and psychiatrist using evidence- based treatments and not having an anti-science bias is also crucial. 7.2.3 The above summary of this Recovery Model which I have just outlined is itself a complex mouthful of words, to say the least. There are many verbal and written mouthfuls, medical jargon if you will, in this field of mental illness(or mental distress to use a term that is often come to be preferred in recent years), as I have indicated before in this statement, and they keep the sufferers of this and other mental disorders as busy as little beavers trying to come to grips with the terminology and its associated mystique. The mystique involved in mental illness or, as I say above, mental distress, is a mystique in some ways not dissipated, but curiously reinforced, by all the new knowledge in this last half century or so. 7.2.3.1 This recovery model puts the onus on the people with the disorder to work out what is their best way to cope and to survive in society, given the conditions of their illness. Such individuals must work out the techniques and strategies for day-to-day living. Sometimes knowing more helps but often, too, as the Danish proverb puts it: ―a handful of patience is worth more than a bushel of brains.‖ Sufferers from BPD often lack that in-built patience due to their emotional imbalances. They often also lack that ‗bushel of brains.‘ 7.2.3.2 When the feeling of paranoia regarding my symptoms comes over me, I say to myself ―something needs to change.‖ I now have many early warning signs that I can act upon that help me avoid situations which produce negative and inappropriate behaviour and interaction with others so that I can remain healthy and happy and fulfilled. I have action plans to respond to the early warning signs. Without the insight that BPD has forced me to acquire I may be like some people I know who get blinded by some stress that appears out of the blue. Without the insights I've gained I would be damaging the
  • 105. relationships that are important to me. I might be walking in a life journey of negative habits, of personal convenience with their attendant social consequences and problems instead of an examined life of choice which is fulfilling. 7.2.4 With each individual BPD is idiosyncratic; individual consumers of mental health services must work out the pattern of their disorder if there is one. In my case, in my BPD, is the pattern a rapid cycling BPD, that is, does it have four or more episodes in one year or do I experience a bout of depression at one moment with extreme giddiness the next, with no lull in between? Such a switch is considered as the worse type of BPD. This pattern is also known as biphasic cycling. I have never had either of these typicalities. Each BPD sufferer must work out what is best for them in terms of: (a) the mental health services and specialists they require and (b) what life activities and lifestyle are appropriate for them within their coping capacity in life‘s day-to-day spectrum. This, too, is a complex question and I don‘t want to dwell on it unduly here. It is my hope that my story may help others to work out their own particular regimen of treatment programs and their daily coping tools. 7.2.4.1 There is no single answer to the question how does a BPD sufferer cope. Sometimes the sufferer copes successfully and moves on and other times the illness takes over and leaves behind a path of destruction. One of one‘s goals is to have a Skills Toolbox to reach into and use in any situation. While the basic principles of coping are the same, everyone has to work out how to apply them and that makes the principles somewhat ‗iffy.‘ There is a need to avoid stress and find balance. How the person practices actual skills and conquers situations may differ completely. The process for me is still a work in progress, as they say. 7.2.4.2 The question of how to cope deals with so many variables that the question of how anyone is expected to master a technique is partly answered by having support, not going it on one‘s own, understanding one‘s needs and making sure they are being met. I have written this account in the hope that (a) I can meet the challenge of filling my Coping Tool Box with skills, ideas, and plans of action and (b) my experience can play a role in helping others. That is why I am prepared to share the story of what works for me here in this lengthy document. In the process readers may learn new possibilities and leave feeling understood and supported. One can but hope. 7.2.5 I have not developed, nor has it been my intention to do so, a comprehensive treatment plan for others to manage their BPD successfully. This hardly goes without saying. During my lifetime I have needed something that worked for me personally. I did not draw on a cookie-cutter idea used for all people with the illness, although my focus on medications has certainly helped me to simplify this complex experience. Some sufferers with BPD develop their own management system to deal with their disorder, to cut the number of their symptoms and to live a more stable life; other sufferers put their hands into the arms of professionals to work out their BPD treatment program. 7.2.5.1 Research by readers on the internet will reveal a number of systems that BPD sufferers use. Readers here will find no such system only the slow working out of regimes and changed packages of treatment over many decades by one person—namely me. One cannot remove a fly from a friend‘s forehead, as an old English proverb says, with a hatchet, an axe or a hammer or, I might add necessarily, with 75,000 words on an internet site. Sometimes all one can do is let time take its course in one‘s own dear life
  • 106. and the lives of others. 7.2.6 The view that a person‘s vulnerability to developing a major affective disorder is genetically transmitted and neurochemically expressed has been strengthened in the years since I have gone off lithium at the turn of the millennium in 2001. The development in this orientation to BPD has unfortunately been accompanied by a philosophy that drugs and various physical/body/somatic therapies offer the best and sometimes the only choice for treatment. This view of what comprises adequate treatment is sometimes short-sighted and, indeed, it may be in my case. I have adopted a strict adherence to a purely psychotherapeutic or purely pharmacological treatment strategy. If the human genome project comes up with a treatment regime that is an improvement on my present medication package, that will result in an obvious amelioration of my present condition, I will change my present treatment but not for any other reason. 7.2.6.1 Although there is some evidence to support the idea that pharmacological treatment alone is not sufficient to prevent relapse, I feel more secure on my new cocktail of medications. Relegating this disorder to the realm of a physiological disturbance that requires medical treatment alone is often considered a serious clinical oversight and a gross scientific presumption, similar to the earlier psychological oversimplifications and prejudices that compounded the difficulties that have inhibited the development of multi-dimensional treatment approaches. However true this is, though, I am hesitant to go off my medication. Any movement in some new direction will only be taken after further consultations with my psychiatrist in the years ahead, the middle years(65-75) of my late adulthood(60-80). 7.2.7 The most convincing scientific progress in psychiatry in the past decade, 2001 to 2011, the first decade of my retirement from FT work, has had little to do with the many talk therapies or the many different medications now available. There has been rigorous, scientific verification that certain forms of psychotherapy are effective and especially cognitive therapy which has received much popular press. This is perhaps not surprising. One of the major insights in the modern biology of learning and memory is that education, experience, and social interactions affect the brain. 7.2.7.1 When a person learns something and remembers it for a long time, it's because genes are being turned on and off in certain brain cells, leading to the growth of new synaptic contacts between the nerve cells of the brain. Insofar as psychotherapy works and produces stable, learned changes in behaviour, it can cause subtle anatomical changes in the brain. Medicine is now beginning to measure such changes with brain imaging. If a person with obsessive-compulsive neurosis or depression undergoes psychotherapy—and if the treatment is successful in changing behavior—the treatment will cause a reversal in the biological markers of these disorders. 7.2.8 It is not my intent in this essay to document the history of mental illness treatment in the last half century or indeed the long history before, say, the 1950s. This is far too big a task and quite inappropriate to my aims here. I should say, though, in relation to the history of mental health problems that, until the last half of the 20th century, the treatment of mental health problems was relatively primitive and based on ignorance. For millennia the treatment of disorders In the mid-19th century was, from a contemporary standpoint, quackery. Nor is my aim to discuss the various approaches that
  • 107. I could have taken to my illness in any detail. 7.2.8.1 William Sweetzer was the first to clearly define the term "mental hygiene", which can be seen as the precursor to contemporary approaches to work on promoting positive mental health. Isaac Ray, one of thirteen founders of the American Psychiatric Association, further defined mental hygiene as an art to preserve the mind against incidents and influences which would inhibit or destroy its energy, quality or development. 7.2.8.2 An important figure to "mental hygiene", would be Dorothea Dix (1802–1887), a school teacher, who had campaigned her whole life in order to help those suffering of a mental illness, and to bring to light the deplorable conditions into which they were put. This was known as the "mental hygiene movement" Before this movement, it was not uncommon that people affected by mental illness in the 19th century would be considerably neglected, often left alone in deplorable conditions, barely even having sufficient clothing. Dix's efforts were so great that there was a rise in the number of patients in mental health facilities, which sadly resulted in these patients receiving less attention and care, as these institutions were largely understaffed. 7.2.8.3 At the beginning of the 20th century, Clifford Beers founded the National Committee for Mental Hygiene and opened the first outpatient mental health clinic in the United States of America. The mental hygiene movement, also known as the social hygiene movement, had at times been associated with advocating eugenics and sterilisation of those considered too mentally deficient to be assisted into productive work and contented family life. 7.2.8.4 Nor is my aim to discuss the various approaches that I could have taken to my illness in any detail. My intention, as I pointed out in my introduction, has several purposes among which is to help those with BPD: (a) to accept the idea that they have a medical a clinical disorder that may be recurrent and that produces symptoms that affect: mood, self-esteem, thinking, speech, activity, sleep, appetite as well as social and sexual behaviour; (b) to identify and label the specific symptoms that occur in their own lives; (c) to facilitate their acknowledgment that their most recent behavioural orientations and/or episodes of BPD can have an impact on the way they and their family members view that BPD; and (d) to identify and describe any change in their attitudes toward others and in the pattern of their relationship with others during and after an episode of BPD and during the long story that is their life. 7.2.9 There are many other more specific purposes which this long essay can serve both for me and for others in addition to some of the general purposes I have already indicated. I will list several of them here before concluding this lengthy account. It is my hope that this essay will assist: 1. the person who has BPD and their carer in being able to examine the changes that occur in the usual care taking roles during: (a) episodes, (b) during changes in medication and (c) during the overall constellation of behavioural patterns of the person with BPD. 2. in helping BPD sufferers in understanding that affective disorders are familial disorders and that they affect others in the family. There are many diagnostic difficulties,
  • 108. difficulties for both the doctor and the client, encountered not only with the early-onset of BPD and first-time episodes as well as with long term accounts especially during medication changes. 3. in explaining the potential advantages and risks of preventive treatment, as well as of no treatment, from the time when the first acute episode is brought under control to the end of life, a long story in analysis, diagnosis, description and treatment. 4. in explaining the importance of long-term monitoring, including laboratory-blood tests and in encouraging the family to share in the decision to initiate or alter maintenance treatment. 5. in teaching the family to distinguish medication side effects and the symptoms of the illness. Note: The term mental distress is often a preferred term to mental illness 8. My Wife‘s Illness: 8.1 Physical: 8.1.1 My wife Chris, who will be 67 years of age in August 2013, also has not been well since 1970. That was the year her second child was born. She suffered from post-natal depression and, when I first met her in 1974, she was still suffering from this disorder. This was her first major episode of post-natal depression. She had a second bout in 1977 with the birth of our only child, but the medications she took were very helpful. In 1982 we moved from Tasmania to towns north of Capricorn in Australia‘s Northern Territory and Western Australia from 1982 to 1987, over 25 years ago. Although she, too, has a long history of different kinds of problems which I won‘t go into here, more recently she has been diagnosed has having an underactive thyroid, and more recently still auto- immune disease. She is taking thyroxin and, after 25 years of the doctors not knowing what the cause or cause/s of her physical problems were, she is finally getting some accurate diagnosis. But there is little she can do about her auto-immune disease which is an unsatisfactory state to be in. There is, as yet, no treatment from the medical-health world. I will report on any major improvement, amelioration of her condition, at a later date if, indeed, her health improves. It certainly has made the domestic scene difficult for both of us. 8.1.2 Chris‘ symptoms in the past have included: dizziness and nausea, back-ear-and-eye ache, headache and some two dozen other symptoms that we have put down on paper to try and monitor on a daily basis and to try and find some patterns. Sometimes, with the aid of steroids or some new drug, or some alternative medical treatment like clinical psychology, she seems to recover for a time, but her symptoms have eventually returned, sometimes mildly and sometimes not-so-mildly. I encourage readers to read-up on the subject of the complexities of auto-immune disease. 8.1.2.1 I often feel that my wife's battle is and has been far worse than mine. She and I live in hope, as I indicated above, that the thyroxin will continue to give her renewed physical health, energy and optimism. New problems of hernia and, in August 2010, a hysterectomy, have come into the picture but, as I have indicated, I do not want to do more than provide a broad-brush-stoke on my wife's difficulties.
  • 109. 8.1.2.2 I could also deal with the difficulties of other family members, close friends and those in my society that have impinged in various ways on my experience of BPD. But, again, these aspects of my life are essentially tangential to the main thrust of this account. 8.1.3 Perhaps the advantages of my wife‘s ill-health, if there are any at all for me, are that: (a) they have allowed me to focus on her problems and to talk about her problems when the subject of health and fitness comes up in our personal and community life as it so often does, and has and will do in the future as long as she continues to suffer from her illness. 8.1.3.1 My wife‘s many health difficulties over the years have helped keep the focus off of my own disability. I can talk about my need for exercise and diet, sleep or one of many other needs, thus avoiding a detailed account of and reference to my own disability and its stigma. People‘s general disinclination to discuss BPD when I bring it up if, indeed, I bring it up at all, can more easily be simply dealt with by shifting the discussion to my wife‘s illness and its symptoms and (b) her many years of coping have provided me with an example of stoicism that far exceeds my own and when suffering from some degree of discomfort I often think of her and her stamina in the face of ongoing physical discomforts of many years. The same principle applies to the problems of other family members and of friends and society in general. There is always lots of stresses and strains, problems and tests that individuals in my life and society in general has to deal with that helps to keep the focus off me. 8.1.4 My many years of experience of BPD tell me the main reason for people‘s disinclination to discuss BPD is an inability to know what to say, among other reasons which I don‘t want to go into here. Consequently, people have little idea of the physical problems I face and much more of an idea of my wife‘s problems. I don‘t mind this for I am not particularly interested in talking about my disability. After 69 years, or perhaps 40 years, depending on how the aetiology of my illness and the onset of its major symptoms, is defined and described, it has become somewhat tedious in the telling and the thinking. I think this has been part of my motivation for writing this account: to put the story on paper and, in part, to put the narrative to bed given the fact that, for the most part, it is so difficult to express in the social domain. It is well-known that people with BPD are disinclined to talk about their problem in public. Such a situation has the disadvantage that people have little idea of the battles faced by sufferers of BPD. When all is said and done in life anyway, we all face our battles alone—hopefully with a little help from our friends as John Lennon and Paul McArtney, as well as the inimitable Joe Cocker and others, used to sing over forty years ago. 8.1.5 This lack of public admission or opening-up can have and has, though, a number of disadvantages. I have a core of friends with whom I can share a broad range of intimacies. Mostly, though, these friends do not tend to inquire and I do not tend to expose these battles, not now nor in the past, except to a limited extent. I have little need to ‗dump‘ on people, as we used to say, not after all these many years anyway. On occasion, when it seems appropriate and with encouragement I do open- up—usually in writing. In the last several years, in the years of this new millennium, 2001 to 2010, I have been ‗coming out,‘ as they say, but mostly on the internet at mental health sites. In
  • 110. the day-to-day round I keep a lid on the subject for the most part. 8.2 Psycho-Social/Family: 8.2.1 My wife has a story here as long as your proverbial arm but to dwell on it, even to describe it briefly, in addition to what I have already written, would lead to one of the many possible tangents and their prolix labyrinths. I could go down many burrows as Alice did in Wonderland as I go about writing this statement, but I shall stay with the clinical, the medical-descriptive, focus on my experience of BPD. 9. Creativity 9.1 Writing: 9.1.1 When I finally came to accept lithium without any mental reservations by the early 1990s; when I began, too, to see the end of my teaching career on the horizon by the mid-to-late 1990s and what I hoped would be a coincidental reduction in the various forms of frustration that I had experienced in marriage, in my career and in my community life in many and complex ways for decades, at least as far back as the 1960s- --I began to write poetry a great deal. One could say I was obsessed; my wife certainly would use that word and I have come to accept that word as a realistic description of my behaviour, especially now more than a decade later in 2013. I have been retired from FT, PT and volunteer work and I devote all of my waking hours when possible to reading and writing, poetry and publishing, research and independent study. The drive, the passion, to create never seems to leave me and other activities, domestic and social, serve to provide a useful backdrop, respite, diversion and alternative, coping tools and possibly crutches, to the constant demand that comes from my inner, my psychosocial world and the philosophico-religious assumptions at the centre of this world. But this creative drive is not in the extreme form that is sometimes reported by sufferers of BPD who, without medication, say that their creative urges would literally push themselves from within until their muscles in their chest and rib cage were torn! Or, as the writer Mark Vonnegut puts it half-humorously and half in a self-deprecating tone: "I have so many original thoughts I have to take medication for it." 9.1.1.1 Phyllis K. Peterson the author of Assisting The Traumatized Soul Healing the Wounded Soul and The Heroic Female Spirit quotes her psychiatrist as saying that: ―when I was studying to become a psychiatrist, there were three known types of bipolar. Now there are 82!‖ at: Bahá‘í-mental-health@yahoogroups.com, 7 June 2008. 9.1.1.2 In an analysis of 520 eminent American women, J.C. Kaufman found that poets were more likely to have mental illnesses and to experience personal tragedy than eminent journalists, visual artists, politicians and actresses. He dubbed this "the Sylvia Plath effect" after the noted poet who had depression and eventually committed suicide. The findings appeared in The Journal of Creative Behavior (Vol. 35, No. 1). There are many other poets who had BPD and committed suicide: Anne Sexton, Sara Teasdale, and Sara Kane, among others. The complexity of Sylvia Plath‘s experience of BPD is analysed at this link. I site this link here mainly because my own efforts to build-up a description and analysis of my experience of BPD have not been easy. This analysis of Plath‘s BPD and my analysis are, from my point of view, equally complex and, in my
  • 111. case, continue another forty years beyond Plath‘s. This is the link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC539515/ 9.1.2 The demand to create is relentless, obsessive, compulsive and disinhibited, but, on the whole this demand exists as a paradoxically relaxed and energetic activity: ―emotion recollected in tranquillity,‖ as the poet Wordsworth once put it. To some extent my writing is at the manic/hypomanic end of the manic-depressive continuum, but it is the end of that spectrum that has been treated and normalized so to speak. My medications, both before and after taking lithium, do not seem to have affected my creativity and this has been especially true on the lithium replacement package of medications after 2001, sodium valproate (NAVAL) and first the anti-depressant luvox(fluvoxamine) and then its replacement effexor(venlafaxine) in 2007. Both of these anti-depressants are useful for dealing with my OCD. 9.1.2.1 Many people without BPD create much more extensively than I do. Creativity is found in the temperaments and personalities of all sorts of people and I do not want to over-emphasize or accentuate its presence in people with BPD. 9.1.2.2 In several studies, University of Texas at Austin psychologist James Pennebaker, PhD, has found positive health and mental health benefits from writing--but only when the writer crafts a narrative or makes connections between thought and feelings. J. C. Kaufman states that poets may not garner the same benefits from writing that other writers do because poems seldom form a narrative. It may case, though, poetry is highly narativistic. Being into poetry is a real tough way to make a living. There are very few jobs that have a higher rejection rate. By the time I was writing poetry seriously in the 1990s, I did not need to earn a living by writing. 9.1.3 I have never been able to write during depression and, once lithium stabilized my moods back in 1980, writing began to flow incrementally and, in time--by the 1990s-- copiously. Creativity in people with BPD, it is sometimes argued, stems from mobilizing the energy that results from negative emotion and to initiate some sort of solution to their problems. Discontent, to put it another way, can be the mother of invention for some BPD sufferers. To put this yet another way: discontent can be adaptive or compensatory because it can spur a person on and force the use of his imagination and, in the process, help him ride out the storms of life. If there are genes for creativity and BPD the research has not indicated it thusfar. 9.1.3.1 From at least 1991 until this year 2013, more than two decades, my literary output has been utterly phenomenal. I could never have predicted it in the first 50 years of my life while I was still employed. To describe the writing process and creativity in general in more than the cursory manner that I have here would take me into another one of Alice in Wonderland‘s borrows where I do not want to go and where I would take myself and readers away from the central theme here—this BPD. 9.1.4 I would like, though, to extend this section on the theme of creativity, in relation to my BPD account by making a brief comment about Beethoven. His music, it is often said, can describe the sometimes abrupt changeableness of BPD moods and their fleeting thoughts. In addition to Beethoven‘s serious chronic physical illness, he suffered from paranoid schizophrenia much of the time. His glory one writer states is, in part, that he was able to arouse the paranoid in all of us through his music. The insane delight of
  • 112. murdering our enemies or achieving kingship over kings, that is the message of Beethoven‘s Fifth Symphony. While most of us have such feelings of paranoia or extremities of mood and passion fleetingly, on brief occasions, Beethoven endured such feelings for years at a time and was able to sustain them in order to produce many a ten minute sonata movement. Of course, neither he nor we actually murder our enemies. Instead we create. He composed music. I write. 9.1.4.1 Composers such as Mendelssohn, Liszt and Brahms had ideal feelings which progressed as they created but, along the way, even they matched Beethoven in gleeful conquering frenzy. There is a frenzy in my creativity but it is nothing like Beethoven‘s. My medications take both the psychological pain and the frenzy away, at least for the most part. I am happy for that, although it took me at least a decade to fully accept this process as I have already described earlier in this lengthy essay. St. Augustine once wrote in his Soliloquies: ―The greatest evil is physical pain.‖ I find this to be true in both the physical and the psychological domains but the pain must be at a certain level, that is, beyond a certain level of intensity. Over the decades I have developed a tolerance for psychological pain but not for physical pain. 9.1.5 Many famous people have success that is attributable to them being in a perpetual state of bipolar hypomania and, in some cases, mania. I often feel, with my final medication package in 2010, I have elements of this perpetual state. Noted bipolar authority Kay Jamison PhD, at a conference in 2002, described Teddy Roosevelt as "hypomanic on a mild day." Bill Clinton, one could argue, is a walking hypomanic poster boy. If you can just find a way to keep your bipolar in the hypomanic end of the spectrum you can become very successful. Scientists now know that bipolar children and adults have too much activity in a part of the brain called the amygdala which regulates emotions and not enough in the prefrontal cortex, the seat of rational thought, a region of the brain which controls behaviours such as impulsivity, and executive function, as well as complex cognitive processes such as working memory, attention and language. The working memory is affected by emotional challenge and people with BPD have more deficits in regions of the brain involved in emotion-processing and regulation. As my wife often puts it, colloquially but in a way that summarizes the effect of my behaviour on others: "you did not think." I often seem insensitive to others, to the effect of my behaviour is having on others. This causes tension in the home and in the relationship with my wife who has to deal with me on a daily basis. When a person gets upset, anxious, depressed or angry these regions of the brain---the amygdala and the right prefrontal cortex---become very active. Perhaps this is the cause of what I have often called over the years, my warrior-mentality, my application of the war-metaphor to my life. In the process of redoubling my efforts, of increasing my struggle with the battles of life, of persevering, of concentrating the forces of my personality, inter alia from decade to decade, I may have just played into these aspects of my brain, my physiological predispositions. I have no idea, really. This is just a theoretical possibility. But, if this theory is correct, it is the reason behind my apparently compulsive creativity and writing. Combined with my OCD and some of the other mental disorders that I suffer from and which I have written about in this account--like PTSD--my BPD produces, results in a somewhat fanatical edge to my present life experience. My poor wife has to deal with me and it is not easy for her. She also has her own problems and coping with me only compounds them---and her problems then impact on me even more with what might be called 'the snow-ball-effect.'
  • 113. 9.1.5.1 In recent research, Dr Richard Davidson, director of the Laboratory for Affective Neuroscience at the University of Wisconsin, has shown that this overactivity in the amygdala and the right prefrontal cortex which makes a person upset, anxious, depressed and angry is quieted through meditation. The left prefrontal cortex, a region associated with happiness and positivity, becomes more active. In studying meditating monks, Davidson found they had developed especially high activity in the area associated with happiness and positivity. 9.1.5.2 I still have a problem with depression, with anger, fear and anxiety but in quite different contexts and to a far lesser extent than I once had or that I have had from time to time in my BPD life. The depression has been severely cut back to such an extent that I do not regard it as a problem, at least not in any of the serious dimensions that I experienced it in the past. But anger and anxiety are different quotients. I have a degree of happiness and positivity mentioned above most of the time and especially when I am writing. The medications I now take have not removed all the deleterious symptoms of my BPD and my other disorders, but they have attenuated their negative features to such an extent that I feel as if my everyday life is as normal as I can expect. 9.1.5.2.1 Perhaps if I was not on medication, if I wanted off my medication or if I wanted to be a megastar or top-performer like those listed below, I might get into the kinds of meditation and talk therapies that have become popular in recent decades. I have now been on various packages of medications for my disorders for thirty years, and over forty years if I go back to my first medication regimes in June 1968 when I was committed involuntarily to a large psychiatric hospital in Whitby Ontario. I have no desire to go off or alter my current regime. My brain activity often needs to be slowed down or dampened and when this is the case I go to bed and try to sleep. After midnight I watch TV to achieve that end, to get an increase in alpha-waves so I am told. As a writer I need a high level of brain activity to keep engaged in creativity and the writing that is a product of that creativity. 9.1.5.3 When I get very tired/sleepy I simply go to bed and sleep. Studies have shown that watching television induces low alpha waves in the human brain. Alpha waves are brainwaves between 8 to 12 HZ and such waves are commonly associated with relaxed meditative states as well as brain states associated with suggestibility. While alpha waves achieved through meditation are beneficial since they promote relaxation and insight, too much time spent in the low alpha wave state caused by TV can cause unfocused daydreaming and inability to concentrate. Researchers have said that watching television has similarities to staring at a blank wall for several hours. This is not a problem for me since my TV consumption is low, less than two hours per day on average. I use TV as a sedative to create the same alpha waves as certain forms of meditation. In addition, of course, I have come to enjoy many programs in these years of late adulthood and my retirement from FT, PT and casual-volunteer employment. 9.1.5.4 The Bahá'í Faith, the religion I have belonged to for over 50 years, teaches that meditation is necessary for spiritual growth, alongside obligatory prayer and fasting. One of the Bahá'í writings makes the point that: "Meditation is the key for opening the doors of mysteries to your mind. In that state man abstracts himself: in that state man withdraws himself from all outside objects; in that subjective mood he is immersed in the ocean of spiritual life and can unfold the secrets of things-in-themselves."
  • 114. Although the founder of the Faith, Bahá'u'lláh, never specified any particular forms of meditation, some Bahá'í practices are meditative. The sign of the intellect is contemplation and the sign of contemplation is silence—as one Baha‘i writing states in a succinct manner. One of the daily Baha‘i prayers is the repetition of the Arabic phrase Alláh‘u‘Abhá , an Arabic phrase for ―God is Most Glorious.‖ This expression is repeated 95 times preceded by ablutions. Abhá has the same root as Bahá, Arabic for splendour or glory which Bahá'ís consider to be the "Greatest Name of God". 9.1.5.5 It is interesting that meditation, the kind of meditation that induces alpha waves, has already helped the following top performers: Steve Jobs, founder/CEO of Apple Tiger Woods, Winningest Golfer in History Bono, Nobel Peace Prize Nominee & Singer for U2 Oprah Winfrey, Billionaire & Media Mogul Al Gore, Vice President & Nobel Prize Winner Howard Stern, Shock Jock & "King of all Media" Paul McCartney, Singer, Songwriter, Beatle Phil Jackson, NBA coach Russell Simmons, $325 million net-worth. Simmons is a hip-hop entrepreneur and meditation evangelist 9.1.5.5.1 Here's a list of well-known people, according to Garret LoPorto, who've already tapped into this power of meditation to reach their full potential: Jim Carey, Robert Downey Jr., Patty Duke, Ben Stiller, Robin Williams, Ludwig Von Beethoven, Francis Ford Coppola, Ted Turner, Buzz Aldrin, Peter Gabriel, Jimi Hendrix, Axl Rose, Sting, Sylvia Plath, Winston Churchill, Theodore Roosevelt, Jane Pauley, Mark Twain, Virginia Woolf.-Thanks to Garret LoPorto, CEO, Media for Your Mind, Inc. Author of The DaVinci Method. The National Alliance on Mental Illness(NAMI) can also add many people to these lists. 9.1.5.5.2 Then there are the multitude of people in history whom various students of history and psychology, psychiatry and medicine, literature and various humanities and social sciences assume had bipolar disorder: 1. The Old Testament prophet Jeremiah according to Harold Bloom in: ―My Favorite Book in the Bible, ― in the NYRB. 9.1.6 Fame and fortune have not come my way, but the act of writing is enough of a motivator and I have hundreds of thousands of readers on the internet which is fame enough for me without having to deal with any of the negative features of celebrity. The fluvoxamine, since 2001, enabled me to work after 11 p.m. if I want to and well into the early hours of the night. Back in the years 2001 to 2004 I could work until after 2 or 3 and sometimes as late as 4 or 5 o‘clock, if I desired---without the black moods. In the years after 2004 I have developed a more regular sleeping regime and am now in bed sleeping on an average of 8 to 9 hours in every 24. I was usually in bed from 1 to 2 a.m. until 9 or 10 a.m. and again for 1 to 2 hours during the day and/or evening. By March 2013, as I write this latest update of my BPD account, I am getting a good 8 hours sleep
  • 115. from 10 hours in bed. 9.1.6.1 The transition to sodium valproate had its problems; this proved to be the case after several weeks of one medication and ten days of the other. As I write this draft #4 of the 11th edition of this narrative to cover the period up to and including October 2011, though, my sleeping patterns as I have already indicated have become more regular. My sleeping patterns in May of 2007, at the onset of my new medication regime more than four years ago, had become more chaotic than they had been since the 1960s; they have altered again and again over the years. This new medication package, initially resulted in quite an unsettled sleeping pattern for several weeks, but that pattern is now---after more than four years---giving me some steadiness, some settling, some routinization of habit and it seems that this new normality of sleeping routine will remain with me. 9.2 My Creativity in a Psycho-Social Context: 9.2.1 My creativity seems to be part of an obsessive compulsive disorder(OCD); but this is only a theory. Whatever my OCD tendencies are, I have never regarded them as requiring treatment; they have become part of who I am. I accept them, as do members of my family, as a sort of eccentricity. These OCD tendencies became more exacerbated after April 2007 when I went on the new medication regime of sodium valproate(NAVAL) and effexor. My OCD behaviours can be and are quite frustrating to my wife with whom I have to interact frequently. At the moment my wife is the only person who has to deal with/put up with my OCD on a regular basis. 9.2.1.1 Emptying the garbage many times a day, doing the dishes to keep the counter in a pristine state, squaring all the bits of paper around the house, keeping my desk and all its papers in a highly organized state are among the several, indeed, the many examples that illustrate this OCD tendency. These manifestations of an OCD were hardly manifest most of my life at least not to any significant extent. But they are now, as I say, outside the normal range of acceptable social behaviour, certainly from my wife‘s point of view. Hypergraphia is a condition causing one to need to write continuously; this disorder is commonly linked to mania and epilepsy, and I might add, OCD. Some believe that the massive collection of over 800 letters Van Gogh wrote during his lifetime could be attributed to this condition. I have written much more than van Gogh and the need to write continuously is certainly present in my case. I will say no more about OCD here. 9.2.1.2 My wife was troubled by my irratic sleeping patterns for the first six months on my new medication package(5/08-12/08), an aspect of my BPD, but has come to accept them. My sleeping irregularities are a tangent to, although an important aspect of, my BPD. My psychiatrist says that, from his point of view, I do not even suffer from OCD. He, of course, has to deal with more extreme examples of its manifestation in his clinical practice. I shall, therefore, leave out further comment on this OCD. Excessive concern for sleep, its quantity and its patterns, is also a common symptom of BPD, but I shall also discuss this no more here as well since I have already written about it extensively and I will say more on the subject later. 9.2.2 The issues of career, various frustrations and anxieties, problems in relationships that we all have in one way or another, the difficulties involved in moving from place to place as I have done over the years, stresses and strains in marriage, dealing with the ill- health of my wife and the eccentricities of others in my family and place of work, while
  • 116. important to me and to my story in a wide variety of ways are somewhat tangential to the central theme here of my BPD. They are all tangents to the main story line. I do not want to underemphasize or overemphasize these other and important aspects of my life in this statement. They are important, but as I have often said above, they are tangents to the theme, however important they may be and to dwell on them would make the focus of this account far too diffuse. These tangential features of my life have all been, each in different, complex and mysterious ways, contributing factors to my outburst of creative writing in the last 21 years(1991-2012) or 31 years(1981-2012), if I extend this overt creativity back to my treatment with lithium for BPD(1980) and, then my first extensively published writing in Katherine in Australia‘s Northern Territory in 1983. 9.2.3 Numerous studies have examined the link between BPD and creativity. Several studies have shown that artists and writers may have two to three times more incidences of psychosis, mood disorders or suicide when compared with people in less creative professions. People with BPD may possess a creativity that stems from their ability to mobilize energy that results, as I have already indicated, from negative emotion. In this way they initiate some sort of solution to their problems. In this case, then, discontent, it seems, is the mother of invention. Creativity and BPD may have important genetic components that are transmitted together inter-generationally as I have also indicated above. There have only been limited studies investigating this genetic susceptibility to BPD. (―Children Of Bipolar Parents Score Higher On Creativity Test, Stanford Study Finds, ― Science Daily, Nov. 9, 2005) 9.2.4 As a final comment on this subject of creativity and BPD I would like to introduce a note on hypochondria which is considered by psychiatry as a variant of OCD and there is some relevance of this subject to my condition. It was a relevance that first occurred to me when I came across the book Tormented Hope by Brian Dillon. This book helped me to place what I want to say here about hypochrondria in a helpful context and to fit my present lifestyle somewhere along the spectrum of hypochondria. My medications, my creativity, my BPD and my OCPD all combine in a fine, a convenient, way, to support the lifestyle my body and my mind desire, as well as the artistic, vocational and avocational purposes that I also desire. All these factors come together to provide me with a basis for my retreat from the world to find the kind of solitude in which to: (a) pursue the new avocational focus on writing that I have developed in these years of my late middle age(55-60) and early adulthood(60-65) and (b) invent, so to speak, the self I desire and need to do my new work, to focus sharply on the literary task that has come to take the central pivot of my life. 9.2.4.1 Dillon says that hypochondria is rooted in a desire for certainty and control in a world where both are very difficult if not impossible to achieve. To put these ideas of Dillon, this hypochondria, in another context, I have come to use my BPD and my illnesses as a critical backdrop to pursue my avocation and forge the independent life which this avocation requires given the obsessive nature of this avocation. My illnesses and disorders nurture and liberate me as much as they hobble, obsess and partially annihilate other aspects of my life. In some ways, although not entirely, my BPD and OCPD are a question of attitude. They are both a bulwark that protects me from a predatory world and allows me to have a fulfilling life inspite of my BPD and OCPD. 9.2.4.2 These disorders combine to provide some of my core life-structuring principles. They are real but they also masquerade in a certain sense as chaos. They help provide me
  • 117. with a resolve, a resolve which contains not-a-little fear. They allow me to appear on the stage of my own life in a way that I can cope. Sometimes it seems as if I am appearing on this stage in the costume of a character in a play. But it is a play I have scripted myself and in a character which is the very persona I want to be. Psychiatrists sometimes characterise the hypochondriac as a neurotic, self-critical and introverted person whose nervous system is like a radio with the volume turned up so high that the background static becomes intolerable. In addition, BPD changes the acid/alkaline balance in the blood which, in turn, produces a range of physiological and psychological effects one of which is to make brain cells behave in a more excited way. Both these descriptions have some relevance to my present state and so I include them here in this commentary on what might be called my hypothesized hypochondria. 9.2.4.3 Looking at the manifestations of my BPD and the general nature of my personality since as far back as the years of late childhood(9-12), 1953 to 1956, it would seem there have been two overall personality patterns. From 1953 until, perhaps, 2003, I exhibited a generally extroverted pattern. I could even term it manic. As I began to enter late adulthood, the years after the age of 60, the more introverted and depressive side of manic-depression was manifest. Part of this could very well be part of the aging process and my activity profile in the lifespan. My energies which had, for half a century, been turned outward in the main to deal with and survival in the employment world and socially--began to turn inward in the main in order to give expression to the creative side of my personality in its engagement with writing.1(1mild mania is conducive to creativity but as one progresses to acute mania the prerequisites for creativity decrease) 10. Concluding Comment: The Road Ahead 10.1 General: 10.1.1 This brief and general account, at least brief in contrast to a whole book that some people write on the subject of their bipolar experience, summarizes both the long history of this illness and where I am at present in what has been a life-long battle. I think it is important to state, in conclusion, that I possess a clinical disorder, a bio-chemical imbalance, having to do with brain chemistry. There is an upset in the balance of different neurotransmitters known as excitatory and inhibitory neurotransmitters which are involved in sending signals in the brain. This lack of balance is seen as central to the disorder. Lithium and valproic acid work by restoring the balance of these neurotransmitters in the brain. Increasing medical and diagnostic skills and knowledge since the 1950s have helped those with BPD so that sufferers are being treated better than at any time in history. With an increasing range of mood stabilisers, anti-depressants and anti-psychotic medications on the market and with the use of a range of other therapies--the perturbations of BPD have been more effectively treated than ever before. 10.1.2 I feel I am a success story inspite of any tendency to gloom and doom that occupies the content of this book. Every day one makes progress or goes backwards, although often what we sense is stasis. Every step we take may be fruitful or retrogressive but, again, so often it seems like nothing has happened at all. Whatever stretches out before you—and I—is an ever-lengthening, ever-ascending, ever-improving or descending path whose journey will never end until, of course, our death. Churchill
  • 118. said that it is this process which, far from being discouraging, only adds to the joy and glory of the climb. Of course, not all of us can be a Churchill and even that Old Battler had to fight the Black Dog and it was not always with success. It seems to me that, however unfortunate it is for you or I to be discouraged and however dismal the outlook appears, labouring serenely, confidently and unremittingly is a useful goal to shoot for— little by little and day by day—even if we do not achieve it in its entirety—and who does? 10.1.3 Depending on what study one reads, there are some three to five per cent of the population suffering from this illness. The extremes of this illness as I had experienced them before 1980 were largely treated by lithium carbonate from 1980 through the 1990s to 2007. But in the 1990s and into the new millennium new medications and, indeed, other treatments became available. The story of all these medications and treatments that have become available is not included as part of this account. I tried many alternatives in my efforts to obtain healing in the years from 1962 to 1980 but, by the time I retired from full-time work in 1999, I was not inclined to experiment with alternative treatments. There are many statistical estimates available from various sources, several degrees and intensities of BPD and other bio-physiological and emotional imbalances that resemble BPD but are not actually BPD. These factors that make the estimation of a specific percentage of people who suffer from this BPD difficult to tie down with a high degree of accuracy. 10.1.3.1 The list of alternative treatment programs is now a long one and I will not provide a comprehensive statement of these alternatives. I have tried many alternatives over the years and that list is a curious cornucopia of hoped-for solutions. These alternatives from within the fields of psychiatry and psychopharmacology and from without, from the burgeoning world of alternative medicine, each have their own story. I have taken fish oil, 1000 mg/day since 2005, with its omega-3 fats as well as several regimens of vitamin and mineral supplements since the 1960s, but I will not enumerate the list of these supplements nor the dietary and food issues that I could also discuss. For me, these are all tangential issues even though, in rich Western societies like my own, lifestyle is sedentary, one's diet is critical and stress is psychological and not physical. 10.1.3.2 I also leave out a detailed discussion of: (a) serotonin and dopamine levels, monoamine oxidase inhibition and its influence on opined peptides such as beta- endorphins sometimes referred to as adaptogens; (b) stimulants like nicotine among others or depressants like alcohol among others; and (c) prayer and meditation in their various forms. But I will make one general comment on serotonin levels which appear to correlate with happiness. Serotonin levels have been shown to correlate with motivation, concentration, energy, sociability, and libido, and to correlate negatively with anxiety. Too little serotonin in combination with other neural changes and we become isolated, lose motivation and the ability to concentrate, and experience increased anxiety. If we have increased amounts of serotonin present in our neural synapses we become full of energy, gregarious, and our libido increases. If our serotonin levels are mildly elevated we reportedly feel ―better than ever.‖ 10.1.3.3 Since our perception of ―external reality‖ is a construction of the brain what goes on in the brain, chemically and electrically, is crucial. Our senses are confronted by a chaotic, constantly changing world that has no labels, and the brain must make sense of that chaos. It is the brain‘s correlations of sensory information that create the knowledge
  • 119. we have about our surroundings, such as the sounds of words and music, the images we see in paintings and photographs, the colours we perceive: ―perception is not merely a reflection of immediate input,‖ some analysts say, ―but involves a construction or a comparison by the brain.‖ 10.1.4 The prescription of lithium(1980) and the addition of fluvoxamine(2003); the changeover to sodium valproate(2007) and venlafaxine(2007) in April/May 2007 each had its own story and its problematic for periods of time in the main for less than two months each as I have described as briefly as I can above. By June/July 2007, after 7 consultations with my psychiatrist, in the January to July period of 2007, it was obvious that the new medication package was giving good results. My psychiatrist and I agreed that, unless some problems arose, I would not come for any follow-up visits. And I did not, but in April 2012 my wife and I decided that I needed to go to another psychiatrist and get a different meds. I discuss this new pkg below. 10.1.4.1 My latest medication package came into my life, then, in April 2012. It became my most recent cocktail, as it is sometimes called in the psychiatric vernacular. In 1980 I had settled on lithium, just the other day it seems in retrospect, although it flowed through my veins and was part of my brain chemistry, to put it more accurately, over some 27 years ago. In the five year period, 5/07-4/12, I worked out—thanks to my psychiatrist--a new and quite satisfactory alternative meds package. As I write this latest edition in April 2012 I very new medication regime which is still a work in progress. 10.1.5 Finding the right combination of meds can be a discouraging process but, thanks to the professional expertise of a psychiatrist, a clinical psychologist or, perhaps, a psychologist, assistance is available to sufferers from BPD. In my case I had a psychiatrist who had specialized for over three decades in working with people who have BPD. I feel I am on the right meds, as medications are often called colloquially. I am not inclined to tempt fate and try some other package, at least not yet. Trust and confidence in one‘s psychiatrist, one‘s specialist, is a critical variable in this whole exercise. 10.1.6 The story of the history of my medication-regime change may not be over yet even after more than four years of the last major shift to NAVAL and effexor and one year on my present medication regime of that medication package. In November 2008 I reduced the effexor level from 75 mg to 37 and ½ for two weeks and then nothing at all on 10/12/‘08—with the view to resuming the 37 & 1/2 level if my behaviour warranted. The change in the quantity of anti-depressant medication, that is of effexor(venlafaxine), produced no observable change in my behaviour or symptoms until late January. 10.1.7 This section is devoted to one of the characteristics of mania which is the opposite of depression. I have come to call it speeding. Rather than a general slowing down of thought and activity which is a very common feature of depression, the person with mania experiences a speeding up of thought and activity. Also, with a manic episode the person's self-esteem and mood are elevated, which is unlike what happens in depression. A person experiencing a manic episode frequently encounters difficulty with relationships and problems at work, at school, or with the law. I experience, even now at the age of 68, a milder form of mania which is called hypomania and which was often called hypomania over the years. The person who is hypomanic experiences speeded-up or pressured speech, thought, and behaviours, but usually/still functions normally. Now, at the age of 68, I only speed when I have been in social situations for too long a period
  • 120. of time and "too long" can very from a few minutes to two or three hours. 10.1.7.1 The medications I take work on monoamines which are a type of neurotransmitter. While not wanting to go into any detailed chemistry of neurotransmitters like norepinephrine and dopamine, I will make a few comments here on the chemical and physiological sources of my speeding, sources connected to these neurotransmitters. Dopamine is said to increase general arousal and goal-directed behaviours and decrease latent inhibition; it also appears to increase the creative drive of a person‘s idea generation. This has led some psychiatrists to what they call a three- factor model of creativity involving the frontal and temporal lobes of the brain and dopamine. 10.1.7.2 This feeling of speeding and/or speeding-up is also characterized by a sense of euphoria. In my case the euphoria is mild, but the intensity of activity is high: running to and fro tidying-up and engaging in much OCD activity until, exhausted, I go to bed and sleep. Blood pressure and heart rate increase as well as other components of the body‘s operating system including glucose and the respiratory system. The problem with the speeding-up of my body is that, as I say, I also get a mild high, a quasi-euphoric state and a degree of sensory confusion. 10.1.7.3 There often follows, after a short period of this speeding-up, say as much as an hour or two, a drop in energy and extreme fatigue and, of necessity, I have to go to bed and sleep. When my head hits the pillow for sleep I can feel a rapid-firing of mental activity which I have to slow down in order to get to sleep. This process nearly always occurs, at least in the last four years, after two to three hours of social interaction. Such extended interaction often leads to inappropriate verbal output if I remain in that interaction beyond, say, three or four hours. I have developed, therefore, a desire not to engage in social activity after this time-period. The above story of my speeding has been the dominant pattern while on my new meds package: NAVAL and effexor. 10.1.8 I had no intention of changing the NAVAL after being on it for four years. My intention at that time, in 2011, was to remain on NAVAL until some advances in pharmacology and psychiatry come my way, until my psychiatrist suggests a change or until I feel the need for a change due to some excessive form of symptoms raising its head again. As my story unfolds and my experience under this new regime advances, I will document it here as succinctly as I can. The major negative side-effects of NAVAL were: a mild diarrhoea, drowsiness and weight gain all of which were neither serious nor debilitating. 10.1.9 I really feel quite and quietly exhausted from: (a) the lifelong battle with this illness and (ii) the soporific effects of my current medication package. I would prefer to continue to live my everyday life quietly and in ways that my health allows with little to no social demands. This anti-psychotic and anti-depressive medication evens-out my mood disorder and its fluctuations. I feel a deep fatigue now in my mid-sixties from a range of sources. My entire sensory-motor experience has been so various both now and over the years that long social interactions are really more than I want to bear, to engage in. I only do so as a result of: (a) unavoidable circumstances, (b) situations which are actually pleasurable but produce emotional exhaustion if carried beyond 2 or 3 hours, (c) my wife‘s persuasion and (d) out of some sense of social obligation but rarely out of any desire on my part. When I do go beyond my psychological limit the consequences,
  • 121. thusfar in these last three years are: (a) inappropriate verbal outbursts in the form of criticism of others and (b) an immense fatigue that necessitates great quantities of sleep for the next 24 hours. 10.1.10 In 1999 I gave up full-time work; in 2003 part-time work and by the years 2005 most of my volunteer work by incremental stages. I have had seven years now, 2005 to 2012, virtually free of all forms of work/employment. In the years 1999 to 2005 I took part in a wide range of volunteer activities from holding a radio program, to participating in a small singing group, to teaching in a school for seniors here in George Town Tasmania, to organizing a series of public meetings, to activities that are part and parcel of my religious and social life. These served as a type of step-down transformer after many years of 60++ hours/week in employment and community activity. 10.1.10.1 Now in April 2012, except for some volunteer Baha‘i work largely involving writing, participating in small public and social meetings of two to three hours maximum duration and doing the inevitable voluntary-necessary domestic activity in my home, my volunteer work has ceased. As I have pointed out above, my social interaction as well as my simple desire for social activity, have decreased markedly. My verbal skills and behavioural capacities still exist but only for short periods of time. 10.1.10.2 Occasionally I must attend to social, family or Baha‘i functions and obligations of more than two hours length, as I say, but such situations are rare and I am usually successful at keeping such occasions to a minimum. When I must spend 4 to 6 hours in some social activity the result is total exhaustion and a determination ―not to do that again.‖ Occasionally, too, when friends or family members stay in our home for a day or more I simply (a) take myself off to my study or (b) go to bed when the social interaction gets too demanding. It has taken several years to learn to do these things to protect both myself and others from the negative verbal behaviour which raises its ugly head after too much social demand/interaction. 10.1.10.3 I seem to have 2 settings in interpersonal situations: off and on. I keep my mouth shut and be invisible or talk and talk and talk. I avoid parties and group gatherings because I get overstimulated and often take over conversations. Medication and knowing when to shut-up or simply not engage , I am confident, helps me find the middle ground. 10.1.11 My short bursts of writing and reading, bursts which add collectively to some eight hours each day, are about as much as I want to handle. Other short bursts of activity, as I say, in the form of: (a) domestic activity like cleaning, cooking, ablutions, watching TV, inter alia, as well as (b) short meetings, interactions with family and/or friends and (c) various other kinds of social activities, which continue to give some variation to my life, also add up to another eight hour total. It‘s a creative milieu and one with significant meaning. In some ways this milieu is more frenetic and in other ways less frenetic than it was on the lithium-luvox package and as it was for most of my years as an adult. 10.1.12 I have now been left in 2013 at the age of 69, after all these decades of BPD, in a quite exhausted, worn-out and enervated state inspite of appearances to the contrary. Many other people, friends and associations, have no idea of my BPD and interpret my lack of social activity, my hermetic preferences, incorrectly. They see my interaction as: (a) being quite normal or (b) having some kind of abnormality and, not understanding
  • 122. my BPD, expect from me what I cannot handle, cannot do without great effort, too much effort, too much debilitating effort. Virtually all of those with whom I interact have little appreciation or understanding of my BPD and its affects with the exception, of course, of my wife—and even then I sometimes wonder! This no longer surprises me for many reasons which I have alluded to at several places in this lengthy statement. 10.1.12.1 Except on rare occasions when I let the veil down and ‗come-out,‘ as they say, the majority of those I meet are left in the dark as to my illness and, for the most part, this does not trouble me. Even then, after some degree of 'coming-out,‘ the understanding of others is limited. I know from many years of experience of BPD that there is little public understanding and much stigmatization of my condition, inspite of many changes and improvements in society and much destigmatization for/of the mentally ill. This is one reason I utilize the internet to: (a) tell my story and (b) help others at over 100 sites on the world-wide-web. In the fields of art and literature and music, there is much more toleration of mental illness than there is in the rest of society. That might allow people with mental illnesses to climb the ranks of poetry in a way they couldn't have done in business. 10.1.12.2 I take on the inevitable and necessary domestic activities, as I have mentioned above, and my wife has become even more, what she has always been, the most critical person in my social interaction scene. Our last child left home five years ago in 2005 and my interaction pattern in my home, in my relationship with my wife, altered yet again as is the case with millions and billions of other people on this planet who go through the inevitable changes along the lifespan in their marital, family, love and relationship life. BPD sufferers in many ways experience the normal problems that are the experience of Everyman. Various domestic activities and a variety of social interaction settings are all within my capacity, as I indicated above, but for the short time periods I have emphasized above. 10.1.13 Now that I am retired and now that I write and read so much of the time a new- old problem has emerged and that is getting the balance right in my relationship with my wife, giving her the care and attention she needs and deserves. But that is a separate and tangential problem. Life has its tests and difficulties until the end of our days on this earthly plane and it is not my intention to describe all my life and its problems and joys in this statement. 10.1.14.1 Periods of physical activity must be kept short; this is necessitated, also, by my chronic obstructive pulmonary disease(COPD) which has resulted in a shortage of breath after even, especially after, a little exercise. The question of physical exercise, though, is complex. It is a separate issue in some ways which, as I have already indicated, I do not want to overemphasize or even discuss here in any detail. I was advised by my doctor as far back as 2001 to do 20 minutes a day of strong exercise, or ―puffing.‖ But after beginning the effexor medication in 2007 I could not find the enthusiasm or energy for such a level of exercise. 10.1.14.2 In 1980 after I had taken on a vigorous exercise program of running for several months I had another bad BPD episode and had to be hospitalized. In the process, I became somewhat sceptical about the positive effects of rigorous exercise for me. I do hope to get back into a gym-sauna-swim program or even do more exercise around the house in the form of domestic activity like cleaning---in the months ahead, but as of
  • 123. March 2013 this has eventuated to only a limited extent. At the moment I follow the advice contained in a book entitled Walk! The emphasis in this book is on walking with some light exercises in the process. This is a form of exercise I have been doing on a daily basis for at least the last 20 years and, since 2007, I have added more exercises as I walk along. I also swim on average 2 to 3 times a month for 1/2 an hour. 10.1.15 There is much in the backdrop of my lifeline, my lifespan, which I could include in this account and I encourage readers to have a look at: (a) my more detailed narrative or memoir if they think that what I write in that longer account might be useful to them and/or (b) my medical notes from the years 1999 to 2011, if they want a more fully contextualized account, an account that gives much more of the story of my life, of which this BPD account is but a part. My memoir of 2600 pages is available under separate cover to readers. Those wanting to write to me can do so to my email address at: ronprice9@gmail.com. 10.1.15.1 The notes I keep from the visits to my GP doctor and my psychiatrist are found in Appendix 4 at the end of this statement. It is often advised that people with BPD have a strong exercise program especially in the morning to get rid of their excess. 10.1.16 When I get ill or get an infection, when I have a cold or a virus, when I am forced due to circumstances to engage in long periods of many days of social activity, as I was in April-May 2009, I feel deathly, non-functional in the extreme and the old death- wish syndrome winds its way into my psyche. Sometimes in such situations: (a) I take disprin, panadol & anti-biotics, drink plenty of liquids and stay in bed as long as I can or (b) I simply sleep as much as I can, withdraw and retreat from life‘s stimulation. The message for me from such experiences is: avoid such socially demanding situations and other social conditions in which I am likely to: (i) catch a cold/virus/sickness of some kind, (ii) get emotionally and psychologically exhausted or (iii) become critical, verbally abusive, over-the-top or ‗blotting-my-copybook,‘ as my wife puts it colloquially. 10.2 Retirement and The Old Age Pension At 69: 10.2.1 I turned 65 in July 2009 and am now on the Australian Old Age Pension(AOAP) and the Canadian Old Age Pension(COAP). I have not worked in full-time employment for some 14 years(4/99 to 3/13) for reasons associated with this illness. I was on an Australian Disability Services Pension(ADSP) from May 2001 to July 2009--eight years. Although I have been treated for the worst side-effects of BPD, I have little energy, enthusiasm or capacity for FT, PT or causal employment or any demanding social and community activity that entails many hours of interaction and long periods of listening and talking. A ―long period of time‖ in social interaction(i.e. formal and informal meetings, large family/social gatherings of more than three people) had become defined, by the time I was regularized on my new medications in June 2007, as any number of hours beyond two. After 2 hours I often, although not always, lose my normal, easy- going self and become critical and verbally abusive. 10.2.1.1 When I unavoidably take part in such social activities, it is usually because I want to please my wife to whom I have been married for 35 years, although sometimes I take part in some community activity out of a sense of duty and social responsibility, an important part of my religious ethos, as I have indicated above. But my preference is to avoid any interaction settings that involve more than two hours of engaged activity. I
  • 124. have said this before in this document but, I know from experience, that this aspect of the current manifestation of this illness is often understated, little understood even by me and needs repeating to underline my point. When I tell others of this fact it is, not surprisingly, often misunderstood or simply ignored. I try to avoid complaint about my symptoms. So much of one‘s life and one‘s behaviour is not understood by others or oneself for that matter. This reality is part of the experience of one‘s journey on this earthly plain. 10.2.2 I have written this statement for many reasons as I pointed out at the outset of this account. Initially it was for an interview with a Centrelink Disability Officer in the Department of Health and Human Services back in 2001 in order to obtain the ADSP. Since 2001 I have written many further drafts of this statement: (a) for internet purposes at mental health, bipolar and depression sites and also (b) to update that original statement because my illness is an ongoing one whose story is far from over. I trust the above outline provides an adequate information base for others to evaluate and understand my situation and/or to draw on my experience in a form that may be of use to them. 10.2.3 I apologise for going on at such length. I know from my experience of 35 years as a teacher and from the many occasions when I have attempted to summarize my experience of BPD, that some readers and listeners tire, lose interest or feel that there is a loss of relevance in the account because of its length. Still others are simply not able to read such a lengthy statement or follow a long verbal explanation. When I post such a statement on the internet such an individual, such a reader, requires that I write in a simple style, write briefly and with simple words. I do not always KISS, Keep It Simple Stupid, as advised in much contemporary business English programs, programs I have myself taught. 10.2.4 When some readers are required to read such a statement like this one: (a) in a formal educational setting, (b) as a member of a government department involved in making an assessment of my condition, (c) in any one of a number of other settings where an assessment of my condition requires reading a lengthy piece/essay/statement like this or (d) simply as someone reading in their leisure-time, the exercise proves too onerous, too uninteresting or too tedious for them. I can understand this reaction for, I too, have my limitations and often am disinclined to read long statements on many a topic. Of course, many others appreciate this more longitudinal, retrospective account and I have had a good deal of positive feedback on the internet thanking me for this analytical, although lengthy, narrative. 10.2.5 This age has become a highly visual one and, I might add, a world with an auditory and sensory emphasis. Reading is only one of many ways people learn and, for many, reading is not their preferred learning mode. Then, too, we all have our constellation of personal interests and I certainly would not expect everyone I meet and who knows me to take any particular interest in this statement any more than I might take an interest in some of their passions and concerns, problems and activities. We cannot all be interested in everything and take part in all of the activities we are encouraged to take part in as part of today‘s world, if we ever could in the past in other ages and centuries. 10.2.6 I felt it was essential to place my illness and my experience of it in context, so to
  • 125. speak. I know there are many, indeed millions, who have problems far worse than my own. But this is my story, my disability story, briefly or not-so-briefly stated. I could say much more and I do so in my autobiography/memoirs for anyone who is interested in reading my story. I would like now to turn to ―the road ahead.‖ 10.2.7 This account of my BPD experience is, in some ways, my construction of a meaning-making narrative. This narrative construction permeates this work, as does an emphasis on historical and social contextualization and interaction over time. There is a Protean Self which emerges from the confusions and contradictions of life experience. This protean person has developed a multiplicity and malleability of self in a process of what might be called a continuous psychic recreation. This recreation allows for a self of many possibilities. This is consistent with the creation and constant re-creation of a "life- story" or meaningful psychological and historical narrative of self that integrates my several identities. 10.2.7.1 Traumatic memory and the events associated with it are experiential, not narrative. This memory takes the form of fragmentary sensory and/or memory re-plays, inexplicable rage, crying, and terror or immobilizing body states. Proteanism has many useful features in helping a person with BPD deal with his ordinary thoughts and actions. Often these thoughts and actions are unconsciously and erroneously assumed to be trivial although holding a wealth of significance. By encompassing multiple forms of interpretation including linguistic, semiotic, and aesthetic; bodily, psychic, and emotional, this protean self provides me with a way to see through the surface, to face the depths of meaning and my roles in its construction. I am able to "listen" to my own "voices" so that I may better hear the voices of "others," to be vulnerable with a cautious, not fearful, stance. Thus, as I read and reread this story, this analysis, several stories, texts, accounts, emerge. Writing this account forces the story into an artificial linearity, in the name of clarity and as a bow to the expectations of readers. 10.3 The Road Ahead: Responses to This 90,000++ Word BPD Story: 10.3.1 I look forward to hearing from anyone in the weeks, months and years ahead should my experience be relevant to theirs and should they want to discuss these issues further. My friends, former colleagues and associations, the fellow members of the Baha‘i community with whom I share this story from time to time and, indeed, many others who come across this account--for the most part on the internet--will each have their own individual reactions to this statement. This is only natural and to be expected. ―Coming out‖ is a popular sport these days and, in spite of appearances to the contrary, I am not inclined to talk about my personal problems in the context of my day-to-day relationships. For the most part we fight our personal battles alone but sometimes, occasionally, we get with a little help from our friends. My email address is: ronprice9@gmail.com; my snail-mail address is: 6 Reece Street, George Town, 7253, Tasmania, Australia and my telephone number is: 03-63824790. 10.3.2 When I do share some of my story, for sharing too is a more popular activity these days, I find others not inclined to be interested anyway or, if interested, they are not sure what to say and so they change the subject and we never talk about it again; or I change the subject to relieve the embarrassment caused by their not knowing what to say. Sometimes, though not often, an engaging conversation ensues about the disorder. As I
  • 126. say above, I am happy with most reactions that come my way, although some reactions require more thought, patience and comment from me than others. Two reactions still annoy me even after these several decades of BPD experience. One type sees me as having no problem and advises me: (a) not to be troubled by it and/or (b) not to talk about it. A second type of reaction leaves a sense of gap, emptiness or distance between me and the other party. If I give the person a series of basic details and the briefest of history of the illness orally or in writing and I get no response, I feel puzzled that the person is not at least curious to find out or understand more. 10.3.3 Most of my ‗coming out‘ takes place, as I say, on the internet and in that medium I can take my time for a more considered response to whatever written reaction results from one of my postings. It‘s a safer zone, cyberspace, at least safer in some respects. The internet also has its pitfalls, its snares and its difficult people with whom to deal. At some sites I get site administrators, moderators and participants wanting me to participate more than I am prepared to do. I have a life outside talking about BPD and writing about it on sites can be onerous especially if one takes part in some 100 BPD, D and mental health sites. At other sites, some participants find my posts too long and let me know in no uncertain terms. I usually respond in writing to written reactions at sites when readers do write to me and I tend to respond within a few days at most unless, as sometimes happens, I am simply not aware of a response that has been posted. Some people write to me at my email address, but as yet very few. Participants at locations on the internet where I keep up a correspondence, as best I can, at these 100 mental health, bipolar and depression sites prefer the degree of distance provided by the internet over, say, a personal email. 10.3.3.1 I would like to say a few things about ‗coming out‘ in relation to employment. If I had admitted my mental health issues at any point in my career when I had to apply for a job and fill in a form it would have been a problem. Filling in a form that required ticking a box for ‗do you suffer from any mental illness?‘ would have resulted in the employer declining to hire me. Occasionally I was honest and on two occasions I was immediately refused a job that had been virtually promised to me. The last time this happened was in 1980 and I determined, after that date, to fill boxes in—in my favour— and I did this to the end of my employment life. Not everything that a man knows need be disclosed or, to put the case most harshly, one has to lie. 10.3.4 When I give this statement on rare occasions to friends, Baha‘i institutions and others whom I think may benefit from what has become quite a long read of 90,000 words, there are a range of reactions not unlike those I have already indicated above, but which I summarize here as: (a) no comment, (b) a feeling sorry for me and telling me so, (c) a set of questions in writing or in person, (d) giving me advice, (e) an honorific comment; for example, a reference to the quality of my writing, the comprehensiveness of the account or its academic tone and content; and/or (e) some combination of these five reactions. I am generally not troubled by people‘s reactions after all these years, although I often have been in the past. 10.3.5 On rare occasions someone wants to strongly advise or assert a point of view; sometimes that point of view is at variance with my own. They might suggest, for example, that I try: (1) various remedies like: special foods and diets, medicinal and herbal solutions such as drinking lots of carrot juice(1960s), (2) praying and meditating more(1970s), (3) using positive thinking or some new age system of thought and
  • 127. thinking(1980s), (4) not talking about the disorder, assuming a position that I‘m really okay and just to get on with my life(1990s) and (5) some treatment like cognitive- behavioural therapy, insight-oriented counselling and care or some other form of therapy that does not use medications but draws, for example, on the field of neuroplasticity, the retraining one‘s brain by creating new thought patterns and trying not to reinforce the thoughts we want to erase by not thinking them or by not going down that pathway(2000s and 2010s). 10.3.5.1 Evidence in the last decade demonstrates that neuroplasticity, a fundamental mechanism of neuronal adaptation, is disrupted in mood disorders and in animal models of stress. Chronic stress, which can precipitate or exacerbate depression, disrupts the capacity for neuroplasticity, while antidepressant treatment produces opposing effects and can enhance the capacity for neuroplasticity. But, as I say, CBT and the virtues of neuroplasticity are, for me, simply interesting areas of knowledge but not treatment venues I seriously entertain now in my late adulthood happily routinized as I am on my medications. 10.3.5.2 I could comment on each of these suggestions in some detail here since they each have their merit and relevance but, for several reasons, I am not prepared to take any of them seriously now, after all these years and being happy with my present treatment program. However relevant some of these suggestions are, and however frequently I receive these suggestions, they each have serious downsides. Positive thinking and various what you might call ‗mental technique‘ approaches do not translate into effective treatment for BPD. BPD is unaffected by attitude and, even if BPD was/is affected by attitude, I do not want to take the reprogramming steps required for improving my coping mechanisms. 10.3.5.3 A peer environment dominated by a focus on attitude as a key to the survival of BPD clients/patients often has the result of isolating a person like myself who is seen by some as a pessimist. Such an attitude is sometimes seen by the sufferer, like myself, as offensive, insensitive and/or ignorant. Of course others, who have a different attitude to my BPD, see me as a stoic or a realist, a pragmatist or simply an experienced person who has learned the ropes and is capable of making his own decisions. The interpersonal environment, the attitude of others I must emphasize, though, is a crucial one for the BPD sufferer. I have not always maintained my emotional cool, so to speak with these suggestions, although here, too, I am improving in my patience and my self-restraint, partly because of: (i) the new medication package I have begun in the last two years and (ii) an awareness on my part that there are other treatment programs of relevance. 10.3.6 We all have to deal with the reactions of others, of course, and these reactions are not always to our liking. Being calm, however much desired, is not always achievable or even desirable for most of us. I must add, though, that this new medication package is certainly conducive to a more calm demeanour for most of the time. As I often say, in trying to summarize the context for the new tranquillity on this new medication regime: ―it is harder for my wife to get a rise out of me than she used to.‖ In the wider social domain, when faced with what would formerly have caused my punitive rebuttals/reactions to some of the statements of others, I exhibit much more patience and self-control. In the day-to-day round in my private domestic life with my wife, my wife‘s verbal stirrings, criticisms and general verbal output which formerly would have stressed my sensory equipment does not do so. My demeanour remains calm and relaxed virtually
  • 128. all the time in our daily life together. 10.3.6.1 This calm and easy-going demeanour, though, is not true on all occasions. My wife could give readers a different view of my interpersonal skills in the last four years on the NAVAL/effexor medication package than the one I have described above---as could my son, my step-daughters, my step-grandchildren, and some of my friends among others. We are each chameleons in our own ways. My life on medications is buy one example. 10.3.7 My wife would say, and I would agree with her, that after two hours in social settings my calm exterior is often lost and I am no longer the genial host when she and I or just I am in a social setting. She might go on to say that giving way to my erotic urges and my irregular inclinations, my passions and obsessive-compulsive desires, as well as to provocations and pressures is also, paradoxically, a pattern that is more apparent in these last 4 years on the new meds(5/07-1/11). These two tendencies, then, calmness and an easy-going nature on the one hand and a giving way to inclinations and pressures in interpersonal interaction on the other, exist side-by-side and in greater intensity on this medication package. 10.3.7.1 I would like to make some extended and more detailed remarks about my incapacity to deal effectively with social interaction for more than about two hours especially on my meds in the 4 years(5/07-1/11), as well as from 2/11 to 3/13. I made the initial remarks on this subject in section 9.2.4 above. My medications, my creativity, my BPD and my OCPD all combine in a fine and somewhat convenient way to support the lifestyle my body and my mind desire, as well as the artistic, vocational and avocational purposes that I also desire. All these factors come together to provide me with a basis for my retreat from the world to find the kind of solitude in which to: (a) pursue the new avocational focus on writing that I have developed in these years of my late middle age(55-60) and late adulthood(60-69) and (b) invent, so to speak, the self I desire and need to do my new work, to focus sharply on the literary task that has come to take the central pivot of my life. While this so-called ‗invention‘ is partly true there are a host of factors that militate against my social engagement beyond a very limited extent. I deal with this in my memoirs and do not want to expatiate on this subject here. 10.3.8 Who knows what lies ahead in my dealing with BPD? At the age of 69 I would like to put this story permanently to bed--forever, never to return to another, yet another, chapter in the long tale, this sequence of events with a long duration or longue duree, to use a French expression in terms of my own life rather than the life of a civilization to which that term is usually applied. But I have my suspicions that the story is far from over. I am able to work at reading and writing for at least 8 hours in total most days in a series of small time periods even after all these decades of BPD. I am still a functioning member of society, but only in certain quite defined and limited ways. 10.3.9 This new pattern is, to some extent, just a repeat of the old, but there are new additions to the old pattern and I have tried to summarize the package of behaviour here. This pattern has become apparent after 4 years on this new medication package(5/07 to 1/11). This pattern contains the following details, details which have altered, of course, as this medication package itself changed in those last 45 months: (a) alternating periods of fatigue and sleepiness on the one hand; and energy and
  • 129. enthusiasm on the other, often within a few minutes making any sustained work/activity beyond one to two hours difficult to maintain; (b) a sleeping pattern as follows: A. (from 5/07 to 12/08): (i) staying awake to 1 to 3 a.m., (ii) sleeping for two hours and (iii) then getting up to urinate and returning to bed; then (iv) sleeping until, say, 5 or 6 a.m. or 9 or 10 a.m. and, finally, (v) sleeping for an hour or two in the day/evening. All of this takes place within a context, as I pointed out above, of short bursts of: (I) reading and writing each day adding up to an 8 hour total of literary work per 24 hour period— and (II) short bursts of other activities(domestic, social and, personal) adding up to another 8 hours; and a sleeping pattern: B. (from 25/12/08 to 5/11): (i) staying awake until 1 to 2 a.m., (ii) staying in bed until 9 to 10 a.m. and (iii) sleeping for 1 to 2 hours during the day and/or evening making a total daily average of 8 hours of sleep/day and some 10 hours in bed. (c) a certain excessiveness/speed in speech patterns and a tendency to dominate/speed verbally in social settings, a lack of moderation, a lack of control as well as an overly, overtly emotional state and over-the-topness, so to speak, which is more problematic when I am, as I say, in those social situations, especially social situations of more than two hours of interaction; (d) a speeding in situations that do not require speeding like: washing dishes, making a cup of coffee as well as other domestic and daily activities just in normal everyday settings and especially after 3 or 4 hours of social interaction; (e) quick alterations in energy levels, for example, hyperactivity to completely fatigued, and with that sudden fatigue and need for sleep; (f) OCD, obsessive-compulsive behaviour: straightening & squaring bits of paper, magazines & newspapers on tables and desks and other forms of tidiness much more than in previous years. My psychiatrist does not see this as a serious problem on the spectrum of OCD behaviour; (g) urination and defecation may be a side-effect of taking effexor. Other side effects which may be due to taking effexor and which I exhibit include: vertigo, impulsive behaviour, insomnia, dizziness, vivid/abnormal dreams, apathy and fatigue; side effects from taking NAVAL include: sedation, nausea and dizziness which I experience occasionally. Beginning in September 2009 I had what is known as benign vertigo and I got rid of it after 2 months with standardized exercises. This may not be due to the meds; (h) defecating with a slight degree of diarrhoea on average once every 4 to 5 hours during the 16 hours I am awake which, with the frequent urination and the off-and-on sleepiness/fatigue has a soporific effect on my general energy levels. It feels as if I am either eliminating waste or getting sleepy/about to feel fatigued just about all the time. I don‘t feel debilitated by this combination of bodily activities, just depleted of any sustained output of energy and, hence, not capable of any sustained physical or social activity; I have become content and comfortable with what might be called a social mediocrity. If I was still a classroom teacher I would not be able to cope with the
  • 130. necessary social theatricality, incivility and control issues, as well as the emotional demand. Back in the 1980s I felt the lithium I was taking was limiting my social and creative capacity and it took me a decade to come to a full acceptance of my medication because I felt it was preventing me from being ‗the real me.‘ But I do not have this problem of acceptance now; indeed, I have not had a problem of acceptance from 1990 to 2012; (i) a nightly dream pattern that is more vivid/abnormal/extensive than ever before in my life leaving me with a dense-and-heavy, somewhat disoriented, feeling on waking; I began taking a panadol pill on going to bed at night to help me feel calm and sleepy and ready to go to bed; (j) perhaps the most important feeling on the negative scale is an emotional and psychological weariness as outlined in section (i) above as well as a tedium vitae, a Latin expression for a weariness of life, from the long years and many scars left from battling this BPD. But this feeling is only after midnight and after 8 hours of intellectual labours; (k) Now that I am back on the effexor(26/1/09 to 1/12) this tedium vitae is even more pronounced especially after midnight and an 8 hour day of reading, writing, research, editing and publishing--at least as I write this 1st draft of the 12th edition of this account on 21 January 2012. 10.3.10 After I completed the above statement in section 10.3.9 I thought that these dozen symptoms taken in total were a little ‗over-the-top,‘ as they say in Australia. The list, though, is accurate. The statement seems a little over-the-top because I am not used to placing all of the symptoms in one place on one page. Some of the above traits, patterns or symptoms, of course, are problems everyone has in different degrees. These symptoms are: (1) the present constellation of behaviours or negative features of my BPD and (2) a cause of concern in some ways more to my wife who has to live with me than they are to me. Being the battler that she is, and my personal carer in more ways than one, she grumbles and grouses more than usual as a result of my eccentricities and/or more often as a result of hers. This is one of the worse side-effects of my behaviour, its effect on my wife but, over time, she has come to understand my behaviour more and more and, with that understanding has come greater acceptance of my behaviours, especially my asocial tendencies. 10.3.11 This tedium vitae, fatigue with life, on the one hand and my negative, strained and over-the-top behaviours after two hours of social interaction on the other are the major bases, raisons d‘etre, of my asocial tendency. My residual death wish remains when my head hits the pillow each night and this contributes, I have little doubt, to this same asocial tendency. There is, though, accompanying this weariness, an alternating or coextensive quiet tranquillity, a tranquillity very useful for the act of writing. This tedium vitae and its accompanying death wish are most pronounced, indeed, they only exist together just before going to bed. I should also add that my writing life, my creativity, is strongly linked to my need for, and taking pleasure in, solitude. I cannot divorce my asocial inclinations from my desire to write, from my creative activity. 10.3.12 I should mention, somewhat parenthetically, that I have had an increase in weight in the last 30 years(1980 to 2012), some 70 lbs. since beginning my lithium, anti- manic, mood-stabilizer, treatment in 1980. This weight gain may be due to my
  • 131. medications since a side effect of both lithium and effexor is sometimes weight gain. I have a body-mass index (BMI) of 31.5. A BMI of 27.5 and above results, some studies show, in a high risk of heart disease and other health problems. This is not always the case though; for example, one study showed that there was an unexpected better survival in overweight/mild obese patients. I am mildly obese. 10.3.12.1 My GP says that my excess gas may be due to my overweight(230 lbs on a 6 ft(183 cms) frame results in a BMI—at the lowest edge of obese, that is mildly obese at 31.5 using a standardized BMI(body-mass index chart). The change in the position of my stomach when I get up may be the main cause of my gas as well as a simple lack of self- control. The expulsion of gas is due to swallowing large amounts of air and gulping food or drink too rapidly, to anxiety and to drinking carbonated beverages. I am not aware that I am swallowing air, although I do eat and drink too fast and have done so all my life. Excessive air in the stomach is not the only cause of gas. For some people, and I may be one, the expulsion of gas becomes a habit and does not reflect the amount of air in their stomachs. This may be the case with me. During the three years on this new meds package I have more gas than ever before in my life. Perhaps this is due, as I say, to a lack of self-control, an ―I can‘t be bothered‖ attitude, fatigue and lethargy. I also have a mild degree of flatulence. While all of this may have no relationship with BPD, this elimination of gas does provide a backdrop to everyday life, may be due to my medications and may have some tangential effect on my mood. It certainly affects my wife since she is a more refined person than I am and she finds all of this a gross habit, even if she gets used to it. I could have left this subject to Appendix #4 and dealt with it under ―other illnesses, problems and health problems in my life since 1999.‖ 10.3.13 The significant others in one‘s life are an important source of relevant feedback and since I have been on the medication—and its several stages from 5/07 to 4/12--and the new meds from 4/12 to the present---my wife has informed me on many occasions of: (a) an increase in OCD behaviour, (b) an increase in speeding and an intensity of various types of what she calls frenetic activity or, more colloquially, fossicking-about, (c) an eccentricity, an over-the-topness or an inappropriateness of verbal responses in social situations and (d) heightened brain activity or hypomania, a sense of speeding-in- my-brain resulting in the feeling of a need for sleep. 10.3.13.1 For the above reasons and due to my wife‘s sensitising me to my abnormalities and eccentricities, I summarise those symptoms here. I will return to the theme of: (a) relevant feedback from significant others in my life and (b) a discussion of the above symptoms in the years ahead, if necessary/useful. In the process I hope to provide more of this ongoing story, a description of my future and the most recent physical, mental and emotional states as I experience these symptoms on the medication regime, a regime I began in the first week of April 2007, settled into with both medications in mid-May 2007 and with the level of effexor from 26/1/‘09 to 15/5/‘11(i.e. 28 months). 10.3.14 For the above reasons it is my view that holding down a full or part-time job would be unwise, although this is no longer an issue on two old-age pensions as I am. My psychiatrist supports me in this view as does my GP each of whom are happy to provide testimonials in support of my decision not to: (a) apply for jobs anymore and (b) serve on any volunteer bodies requiring extensive/long periods of social interaction. They were happy to support this position, my view of employment, when I was on the Disability Services Pension which did not require me to work. This has been the case
  • 132. since May 2001 when I was 57. I have been on two old age pensions for 4 years(7/09- 10/13). This life-status-situation, as I say, does not require me to engage in employment. I should reiterate, though, that my psychiatrist does not regard the symptoms (c) to (i) in section 10.3.8 above as problems of a serious or even minor nature, insofar as the excesses of my BPD are concerned. 10.3.15 During the eight years 2005 to 2013 I: (a) brought the little volunteer activity I was still engaged in to an end, and (b) limited my taking-on any new work as much as possible due to the presence of the range of symptoms I have outlined above. Social and community responsibilities, situations and activities that go for too many hours, as I indicated above, are emotionally exhausting. I had no desire to take part in them and eliminated them from my life as far as this was possible. I always avoided, if at all possible, what would once have been my community and social commitments. Being on the AOAP and the COAP, as I indicated above, makes the issue/the necessity of employment FT, PT or casual work non-existent from the standpoint of Centrelink and employment bodies. Volunteer groups, like the Bahá'í communities, various fund-raising groups and local organizations in the town in which I live, still seek my assistance. But I rarely say ‗yes.‘ Saying ―no‖ is sometimes a difficult task especially when: (a) expectations are placed on me by group/family members and (b) explanations are both difficult to give and difficult to be understood by those to whom they are given. I have already discussed this subject above and no more comment is required here. 10.3.16 I will describe below some of the details of my medications in the last three years largely for my own interest and memory since, unless I write these details down, I cannot remember them. I have now been on variations of this new medication package for nearly 5 years, 5/07 to 4/12. The last two half-hour consultations with my psychiatrist were on 13/11/07 and 13/11/‘08 and the results of these consultations are outlined below in Appendix #1. The stages in the reduction of my anti-depressant, effexor, levels were advised by my psychiatrist and I have described them above and below as those changes continued. 10.3.17 The other symptoms I outlined at the last visits to my psychiatrist were not considered problems to deal with insofar as medication alterations were concerned. Three weeks after my 30/11/07 consultation, I decided to reduce the effexor levels from 150 mgr. to 112 and ½ mgr. I remained on this reduced effexor level for five months, that is from 24/12/07 to 12/5/08. Since: (a) I was still sleepy/ing too much of the time and (b) I felt the need to regularize/routinize my nighttime sleeping patterns, on 12 May 2008--I reduced the effexor level to 75 mg. per day. I have reported the results of this medication change as alterations in my behaviour patterns and life-routines became apparent. After seven months(12/5/08 to 13/11/08), though, I was: (a) getting five to eight hours of sleep per 24 hour period and (b) my wife saw my demeanour as ―clearer— in my eyes,‖ as she put it, by which she meant there was greater clarity and less sleepiness in my physical/facial expression. 10.3.17.1 I have appended to this statement the notes from the last two consultations, 30/11/‘07 and the 13/11/‘08, with my psychiatrist in appendix #1. They may be useful for others who read this statement and ponder on the relevance of note keeping in general in relation to their disorder and in relation to visits to doctors in particular. These notes can be found in Appendix A.
  • 133. 10.3.18 In November 2008, as discussed in the 13/11/‘08 consultation with my psychiatrist, I reduced my effexor level to 37 and ½ mg. and on 10 December went right off the effexor. I had originally gone on the anti-depressant, luvox, in 2001 to reduce the nighttime blacknesses and I decided that if they returned I would increase the effexor level to 75 mg./day. After six weeks on no effexor(10/12/08-24/1/‘09), the dark side of BPD returned. The above symptoms have continued, although I: (a) am sleeping more soundly with a solid 8 hour per day average, (b) am disinclined to get up once I have gone to bed and (c) have a heavier feeling in my head once I wake up which dissipates if I lay in bed half asleep for an hour or more on waking. As I noted above, though, on 25/1/09 I went back on 37 & ½ mg. of effexor daily for the reasons outlined above and after one year, to 1/10, my intention was to stay on this present regimen for as far as the eye can see. 10.3.19 Altering the brain and its chemistry through medication, alters so many things about one‘s life. One becomes a different person since the brain is the central data processing unit in the body and this processing takes places differently due to different chemistry in the brain. It goes without saying that this alteration in brain chemistry and, therefore, behaviour is also true as a result of drinking alcohol, taking mood enhancing drugs or ingesting one or more of many a chemical/pharmaceutical on the market today. Effexor, to choose one example from the many medications I have taken since the mid- 1960s, belongs to a group of antidepressant drugs called ―selective serotonin reuptake inhibitors(SSRIs)‖ and their very name is a good example of the terminological difficulties involved for those who persist in trying to understand BPD. This ongoing story has been, is and will be partly about that different person I have and will become as a result of my BPD and the medication changes. I hope the above account is as much use to others as it has been to me in writing it over these ten editions and, perhaps, as many as five drafts for each edition, in the last decade. Much of the personal use, though, is: (a) to help overcome the deficiencies of memory, (b) to provide a base for changes I might want to make and (c) to give me a sense of security that comes from writing things down. 10.3.19.1 It will be necessary, of course, to make alterations to the above document in the months and years ahead to: (a) include new information and new perspectives on my past experience, (b) add to the document as changes to my life occur that are related to my BPD, (c) maintain as comprehensive and succinct a story as possible; and, finally (d) to bring those to whom I write this account up-to-date on this story. Research shows that anti-depressants can cause the cycling of the bipolar condition to increase even in the presence of mood stabilizers(―Mariette Hartley triumphs over bipolar disorder,‖ 8/1/2003 in USATODAY.com). 10.3.19.2 I would not characterize my behaviour on these new meds in the last 5 years, and especially the last 18 months, as ‗rapid-cycling,‘ Rapid cycling is a term applied to BPD patients who have had at least four episodes of mood disturbance in the previous year. Most people have a broad range of positive to negative behaviour but rapid cycling has a severity of mood shifts and two is the greatest number of shifts I have had in any one year: 1963, 1964, 1978, and 1980. 10.3.20 There are now 100s of people at more than 100 BPD, D, mental health, general health and other internet sites for whom and to whom I write this account or part of it. Most of the correspondence that has ensued from this posting takes place, as I said
  • 134. above, at the internet sites. There are, as well, a very small handful of personal friends and relations to whom I have sent this story for a range of personal purposes. Some in this latter group want to know this story. I feel it necessary, for various reasons, to inform others so that they have a better understanding of my present situation and past condition. But whatever the reason for my utilising/writing this account, its contents have become of value to many others who suffer from this disorder, similar disorders or, indeed, have other problems of the human condition that possess a traumatic or quasi- traumatic quality, particularly in the areas of depression and men‘s issues which have become more topical and discussed more frequently in recent years. 10.3.21 Given the complexity, subtlety and difficulty in comprehending BPD and its many manifestations, written descriptions of this disorder and/or people‘s experience of it do not necessarily and/or immediately produce any significant degree of understanding on the part of others. In addition, the very length of this written account, to reiterate an important point in the communication process, puts many off. This is due to a host of reasons associated with people‘s disinclination to read long passages on the internet, a medium which for many is used to focus on short and pithy messages and quips, what one might call a kind of ―internet-speak.‖ Even long passages anywhere else for that matter can be too onerous for many people, thus making the transmission of content like that contained herein difficult for the communicator, namely me. Even my own personal understanding of the labyrinth, the twists and turns, of BPD keeps me busy. Understanding does not come easily here for the lay person. And I am a lay person. My story, like so many stories in life, is a work in progress. I look forward to receiving feedback from anyone who feels moved to write words either of encomium or opprobrium, praise or criticism, to make suggestions and/or to outline their reactions to this long essay/report. As I have indicated above in this statement, this 13th edition, I have included a record of information that I keep as a result of visits to my GP. This BPD does not exist in a vacuum and, for some readers of this account, this largely peripheral information may be of value. I have included this record of issues raised with my GP here, as I say, in Appendix 4. My epic 2600 page memoir or autobiography is also relevant for keen readers as a base for the context of this BPD, a context that is my life. Readers wanting to examine this life-narrative can go to: (a) eBookMall, (b) Baha‘i Library Online or even (c) google the phrase Pioneering Over Four Epochs for great slabs of my story. And, finally, I have included a personal email and comment in Appendix 6 from Garret LoPorto, author of The DaVinci Method, to provide a personal context from one of the popular authorities in the field of the study of BPD. 11. A NEW PSYCHIATRIST AND A NEW MEDS REGIME: THE FIRST 12 MONTHS--16/4/'12 TO 16/4/'13 11.1 On 16 and 23 April 2012, as well as on 9 May and 10 August 2012, I had consultations with a new psychiatrist, a Dr. George Hyde, in Launceston. I began a new program of pharmacology, pharmacotherapy, or drug therapy. I had a one hour, a 20 minute, a 40 minute, and finally a 30 minute consultation, respectively, on these four occasions. At the end of the 4th consultation we decided that: (i) I would not call to make another apppointment unless some problem occurred, or unless I was in need of more advice, (ii) I was happy with my progress on the new meds, and (iii) I would now be in
  • 135. the hands of my GP in George Town to discuss any immediate problems that arose. I wrote a four page report to put my GP in the picture and Dr. Hyde sent an email to my GP for her files informing her of my current status. After 12 months on this new medication cocktail, I talk to my GP briefly once or twice a year in relation to my BPD. Mostly of my discussion with my GP, and other doctors, are about other matters. 11.2 I discussed my OCD and decided that it was my responsibility not to annoy my wife with my OCD habits. The key here in relation to my relationship with my wife was to exercise more restraint when it was clear that I was bothering her with my OCD habits. My wife and I had decided over the first 4 months of 2012, before seeing this new psychiatrist, that it would be a better life-style pattern if I did not sleep during the day, and if I had more energy to exercise and do physical work around the house. In the process it would be hoped that I might reduce my cholesterol levels and weight, as well as be more gregarious. I had gained 70 lbs since 1980 on meds for BPD. My wife wanted to have my old social self back, the self I was like back in the years I was on lithium(1980-2001), and in my early middle age(1984-1994) as well as my young adult stage(1964-1984) in the lifespan. After one year on this new package of meds, I can say she has some of the old-me back, but it does not appear that I will ever be as gregarious or as energetic on these new medications. 11.3 On the last meds package from 4/'07 to 4/'12, I did not have the enthusiasm to exercise sufficiently to get my weight off. It was my wife's hope that I would also, as I say above, be more gregarious and be capable of enjoying more than 2 hours of social activity at a time without losing my edge, my self-control, without speeding, as I had done in the last five years on my NAVAL and effexor meds package. Dr Hyde was a psychiatrist whom my wife regarded as more modern and inclined to use the latest medications and approaches to my BPD. He might even help me initiate some CBT therapy if I wanted to go down that route---such was the view of my wife, the most important person in my life-narrative both now and in previous four decades. 11.3.1 I decided by the end of my third visit with Dr Hyde that, for the present time, I would not engage in any form of talk therapy:CBT or otherwise. I had been with my previous psychiatrist for a dozen years, 2001-2012. This new chap was 40ish and not 70ish like my previous psychiatrist. He was a colleague of my old psychiatrist, and both my wife and I were more than satisfied with his service after these visits. I told Dr Hyde that I was coming to him due to my wife's insistence that I try a new psychiatrist, and I asked him to convey my best wishes to my old psychiatrist. 11.4 As a result of these 4 consultations I became stabilized on a seroquel-effexor package. Seroquel is an atypical antipsychotic. These came into use in the 1990s and were approved for the treatment of BPD by the FDA in the USA. It is one of the neuroleptics which is just another word for an anti-psychotic, a tranquilizing psychiatric medication primarily used to manage psychosis for BPD sufferers. Typical antipsychotics, sometimes referred to as first generation antipsychotics, conventional antipsychotics, classical neuroleptics, traditional antipsychotics, or major tranquilizers, are a class of antipsychotic drugs first developed in the 1950s and used to treat psychosis. Typical antipsychotics may also be used for the treatment of acute mania, agitation, and other conditions. The first typical antipsychotics to enter clinical use were the phenothiazines. Second-generation antipsychotics are known as atypical antipsychotics. Most of the drugs in the second generation, known as atypical
  • 136. antipsychotics, have been developed more recently, although the first atypical antipsychotic, clozapine, was discovered in the 1950s and introduced clinically in the 1970s. I write this information, and outline these terms, largely for my own use, but also for others at the many mental health internet sites to which I belong. Dealing with BPD requires, at least for me, as much familiarity with the medical, the psychiatric, language as possible. 11.4.1 Both generations of medication tend to block receptors in the brain's dopamine pathways. Antipsychotic drugs encompass a wide range of receptor targets. The atypicals are less likely to cause abnormal body movements, or motor control disabilities in patients. They are now deployed as: antidepressants, anti-anxiety drugs, mood stabilizers, cognitive enhancers, anti-aggressive, anti-impulsive, anti-suicidal and hypnotic or sleep medications. Seroquel began to be used to treat BPD in 2004 as a tranquilizing psychiatric medication primarily to manage psychosis but, as I say, it is now used for the other purposes especially PTSD. 11.4.2 Seroquel has come to be increasingly used in the management of non-psychotic disorders and as an add-on with medications like effexor to treat: depression, episodes associated with bipolar I disorder(my disorder), and schizophrenia. It is also used as an adjunct therapy to and maintenance treatment with NAVAL. I went off NAVAL after only 7 days on this new medication-Seroquel---in April 2012. Seroquel is also used to treat conditions such as: OCD, PTSD, borderline personality disorder, and Tourette/'s syndrome. It is my view that I have some symptoms of all of these disorders, as I point out elsewhere in this lengthy account of my experience of BPD. 11.4.3 Since Seroquel has also been used by physicians as a sedative for those with sleep and/or anxiety disorders to calm people down, it turned out to be the perfect medication to accompany NAVAL and effexor, or just effexor as was my case by 23 April 2012. After the 2nd appointment with Dr Hyde I went off the NAVAL. I kept 500 mgs of NAVAL for the first week and on 23/4/'12 I went right-off the NAVAL. By my 3rd appointment in early May 2012 I was on 100 mgs of seroquel, but I reduced it to 75 mgs later in May because I was too sleepy. As I write these latest words on 15 April 2013, I have been on the seroquel for 12 months. I took 50 mgs of seroquel for the first week, 100 mgs starting on 23/4/'12 and 75 by 23/5/'12. I took a 50 mg and a 25 mg tablet between 6 pm and 8 pm for ten months. In March 2013 I began taking the seroquel at 9:30, half an hour after another medication called duodart for my enlarged prostate. By the time I am up and have had my morning medication is is usually between 9 and 10 a.m.; seroquel is at its lowest level of effect by then, thus ensuring that I have energy for the day ahead. By 10 a.m. I have been out of bed for 2 hours at the most. I take a 75 mg effexor tablet on waking, between 8 and 10 a.m. approx. Again, I keep this information largely for myself to help me remember when changes took place in my meds. This is all part of my personal longitudinal study and information base. 11.5 The general effects of this new medication package have included: (a) a slower movement, and a very relaxed, slightly euphoric, state, (b)less anxiety and sleepiness during the day, as well as more calmness. I went to bed usually between 7:30 and 8:30 p.m. for the first 10 months, as I say above, and I got up for those first 10 months earlier, usually between 7 a.m. and 8 a.m. at the latest. In the first two days when I was also taking NAVAL I felt, what you might say, "out-of-it" in my daily activity. I only had enough energy to walk about slowly and go about my domestic activity slowly: eat, wash
  • 137. dishes, read and send emails, watch TV and chat with my wife, inter alia. By day 3, though,I had more energy. I still had that slightly euphoric and relaxed state. I mention these things because the transition from one medication package to another is often complex and frought with problems. The most common side-effect of seroquel or quetiapine, as it is also called, is somnolence. This does not surprise me now after 12 months on this new anti-psychotic drug. I am still in bed for 11 hours a day and I sleep for at least 8 to 9 hours. In addition my energy levels are higher than on the previous medication package that I had been on for 5 years. I don't exercise much more on this new meds than on the old, and my gregariousness has not increased significantly. I mention this because my life-style for 50 years, circa 1955 to 2005, was highly gregarious and energetic. In the last 5 to 8 years I have had to settle for a more solitary, far less gregarious life-style. 11.5.1 Other common side-effects listed in the description of this medication and which I can see occurring due to my being on it now for 12 months include: sluggishness, fatigue, weakness, dry mouth, and less libido. After begi8nning to take the medication for my prostate, my libido was reduced even more. I am pleased with this decrease in libido because I tend to be more relaxed and less turned-on sexually. This pleases my wife. Dr Hyde suggested I begin on seroquel at 100 mgs and adjust it to 75 mgs if I am too sleepy: and this I did as I point out above. Any lower a dose of seroquel and there is little effect on my mood, behaviour and sleeping pattern. I'll report on any changes and on these side-effects in the days ahead as this new meds package continues. 11.5.2 I am much less frenetic and do far less speeding on this new meds pkg. After varying amounts of social interaction, though: (a) I have a strong tendency to speed, (b) I experience the related anxiety with its tendency to "go over the top",lose my self-control, and (c) I get sleepy and need to close my eyes in company after 1 to 2 hours. If I monitor this tendency, that is, if I simply eliminate social interaction after a certain length of time---as I did on my previous meds package---I have no problems. Anger still occurs and this frightens my wife, but anger episodes are rare and not as intense as they were from the age of 18 to 58 when I went off lithium. In the last dozen or so years, 2001- 2013, with new meds packages, I have rarely got angry, but it is still something I have to monitor. In the first 12 months on this new meds package I have got angry twice. My wife's ill-health, her auto-immune disorder and/or chronic fatigue syndrome, makes her less patient and this exacerbates the problems that arise from my anger. 11.5.3 It concerns my wife when my interaction is not appropriate: (i) anger, (ii) saying things that are not appropriate and (iii)doing things that are not appropriate especially in social settings. This was one reason for this meds shift back in April 2012. A second major concern of my wife is, as I say above, my OCD which has been high since going on NAVAL more than 5 years ago, and my OCD has remained high on this new meds package--from my wife's perspective. When left alone or just dealing with everyday activity with my wife around the house, I don't speed or experience any anxiety. My wife tells me that I thrash in bed far less. She also says that my facial expressions are more relaxed as is the sound of my voice and general demeanor even in social situations with others. 11.5.3.1 Dr Hyde says I am a classic BPDI since I have had at least 1 full manic episode in my life and I have high highs and low lows. BPDII people never have a full manic
  • 138. episode, just hypomania as well as highs and/or lows. I am also defecating 2 to 3 times a day on average and not 4 or 5 as was the case on my previous meds. My feces are not as loose as they were on NAVAL. I will visit Dr Hyde again at a date when I feel it useful to continue our consultations---which may be a year or two from now or even longer--- time will tell as circumstances change. A PROSE-POEM ENTITLED: SEROQUEL SEROQUEL A Peaceful New Meds Regime Part 1: In the period 16/2/'12 to 16 April 2013, I‘ve been taking my anti-psychotic medication, Seroquel, later in the evening than my usual 8 p.m. By 10:30 or 11 p.m. after taking the seroquel at 9:30 p.m., and after a busy day of writing and publishing in cyberspace, the somnolent affect, Seloquel‘s major side-affect, has set-in. Watching TV until sleep takes over is about all I‘m good for. I don‘t mind this; it is a peaceful way to end the day with my many hours(usually 6 to 8/per day on average) of writing and editing, poetizing and publishing behind me. My wife has usually gone to bed by 10:30; I also enjoy a late- night snack during those late hours, as well as a pleasantly euphoric state. This Seroquel has been in my blood-stream now for one year and I have averaged 11 hours in bed daily for an 8 hour sleep. I won‘t give you the details of my bi-polar (BPD) life from 18 to 68, since I have provided a detailed outline of my experience of BPD over some 70 years in several places in cyberspace. I just want to comment, here in this prose- poem, on the activity of one of my late evenings, early nights, an activity that has taken- place due to the change in when I take my medication. From about 11 p.m. to 1 a.m. last night I watched parts of three programs all of which moved me to write this little prose- poetic piece. Part 2: Seven Ages of Britain is a BBC television documentary series which is written and presented by David Dimbleby(1938- ), the British BBC TV commentator and presenter of current affairs and political programmes. This seven part series was first aired on Sunday nights on BBC One in 2010. The series covers the history of Britain's greatest art and artefacts over the past 2000 years. Each episode covers a different period in British history. In Australia, all seven episodes aired on ABC1 in 2010; the series was repeated in 2013. Last night was Part 6: The Age of Empire. The British Empire ended, as far as Dimbleby was concerned, in 1911; at least he saw 1911 as the year of the start of the decline of the British Empire. This program, indeed the whole series, would have been useful when I was a modern history teacher back in the early 1990s. Alas and alack, I am now retired from a 50 year student and employment life: 1949 to 1999, and I now do all my teaching in cyberspace in my role, my recreated self, as writer and author, poet and publisher. Part 3:
  • 139. The second program I watched last night thanks to my new meds regime on Seroquel was entitled Seraphine. It was a deceptively subtle tale based on the true story of the life and art of a simple and single middle-aged maid. She was discovered by a German art critic in a small French town on the eve of the First World War. The protagonist, this maid-artist, is no tortured genius, nor an angry rebel, nor is she in some sexual whirlwind. She is beatifically happy in her gentle simplicity. This cleaning-maid, self-made artist, becomes mentally-ill, and is put into a lunatic asylum. She achieves a strange kind of bliss, eventually stops painting, and dies in 1942; her art becomes famous and respected. I was fascinated by her obsession, her bliss, her love for art, for painting. The border-line between normality and mental-illness is also a theme which this film presents to viewers, as does the third, the following, program I watched last night. Part 4: This third program was a film I had first seen just after I retired from FT, PT and most volunteer work in the years 1999 to 2005. I only watched the last few scenes last night. Roger Ebert, the American journalist, film critic and screenwriter, who has been described as "the most powerful pundit in America," wrote about the main character in this film, Falling Down. ―What is fascinating about the main character,‖ wrote Ebert, ―is the core of sadness in his soul. By the time we meet him at the start of the film, he has gone over the edge: a psychotic break due to severe stress. But there is no exhilaration in his rampage, no release. He seems weary and confused, and seems to be running through some preordained script.‖ –Ron Price, Pioneering Over Five Epochs, 28 & 29/3/‘13, 11:00 p.m. to 1 a.m. In my three psychotic-breaks I followed no script, but I was weary and confused, sad and withdrawn; I lived for a short time in a parallel universe. It was a strange place that I could not leave fast enough…I was a person pushed to the very limit of my normal coping capacity!! I was Mr Average Person & my mental illness was due to events both external and internal, stress, a compilation of stressful events, and body, a physical chemistry!! Now I drift-off slowly on these new meds, one an atypical anti- psychotic which is a treatment for my bipolar dis-order. This tablet of: Quetiapine fumarate is one of the most well-tolerated
  • 140. neuroleptics of the many atypical anti-psychotics, and it reduces the incidence of any extrapyramidal— movement disorders, a possible problem. I‘m on a low dose of 75 mg; it serves as a binding agent of more and more serotonin receptors; it is an H1 antagonist for the H1 receptors in my brain with plenty of histamine effects. I don‘t really understand all of this, but I can tell you: it helps me to have a very good sleep after my 12 to 13 hours.1 It‘s a peaceful new regime and I can go the distance watching TV late in the evening, and of my life, drifting- off with my brain completely turned- off after my day‘s regime of lots and lots of brain-and-intellectual activity. 1 Quetiapine or Seroquel is used for aggression, anger management, anxiety, bipolar maintenance, depression, mood disorder, post-traumatic stress disorder, suicidal ideation, sleeplessness, obsessive-compulsive disorder, borderline personality disorder, and Tourette syndrome, all of which have been part-and-parcel in complex and various ways, of my mental health issues over the years. Ron Price 29/3/‘13 to 15/4/'13. CONCLUDING WORDS I trust the above provides a more than adequate account of my 70 years of dealing with BPD. As my months and years go through these middle years(65-75) of late adulthood(60-80), I will add more to this 13th edition, this account. I will do more editing, and make the 14th edition for 2014 some time in the early months of 2014. Ron Price 13th Edition Draft Number 1 For 15 October 2013 160 Pages(font 12)....No of Words: 95,000 600 words per page on average.... ronprice9@gmail.com Tel:03-63824790(from mainland Australia) Tel: dial the international access code # and then: 613-63824790(from overseas) 6 Reece Street Pipe Clay Bay South George Town
  • 141. George Town Tasmania 7253 Australia INTRODUCTION TO THE FOLLOWING TEN APPENDICES The following TEN appendices embellish the above account for the special interest of some readers and for my own purposes. These appendices give this account a greater degree of comprehensiveness and utility for different contexts, contexts of use to either myself or others, or both. For a more fully comprehensive statement, of course, readers need to see this statement in the context of my five volume, 2600 page, autobiography available at Baha‘i Library Online. APPENDIX 1: My statement from the first year with my present psychiatrist is found above. The following appendix is: THE STATEMENT RESULTING FROM THE LAST 2 CONSULTATIONS WITH MY PREVIOUS PSYCHIATRIST. I was with my previous psychiatrist from April 2001 to April 2012. DATES OF THOSE LAST TWO CONSULTATIONS: 30 NOVEMBER 2007 AND 13 NOVEMBER 2008 Preamble: My aim here is to state as succinctly as possible the new set of symptoms as they had developed by November 2007 since I began a new medication package of sodium valproate(NAVAL) and venlafaxine(effexor) in April/May of 2007. These symptoms were exhibited firstly, as of 30 November 2007, the date of the first consultation summarised below with my psychiatrist; and secondly, as of 13 November 2008, the date of my final consultation. I have now had seven years(2001-2008) of very helpful consultations with my psychiatrist in Launceston Tasmania. I have not visited him since November 2008 and, since I now have a new psychiatrist with whom I am happy, I will not see him again. He was a specialist in treating BPD, although I know from my long experience in having my BPD treated, that both professionals and non-professionals all have their own inevitably subjective evaluations and estimations(as I have mine) of the expertise or non-expertise of the quality of such professional service. I was under the care of this previous psychiatrist for 11 years. A second aim here is to write the account of the experience and the results of each of my consultations, beginning with the one on 30/11/07 and ending with the last one on 13/11/‘08. I have been keeping such summaries since 2001, but in a more cursory note- taking fashion. These are, as I say, my thoughts and experiences relevant to the new medication package and in more detail than my notes had been from 2001 to 2007. In this way I am able to state before, during and after the consultation, the latest symptoms that concern me in a more reflective and summary fashion than in the somewhat spontaneous and less-thought-out manner than is usually the case when I meet in each session with my psychiatrist. This statement below will also serve to outline the process and the results of these consultations and future ones for use by myself and relevant others: (a) with whom I
  • 142. correspond, especially on the internet at mental health, BPD and D sites; (b) whom I feel would benefit from knowing about my most recent experience with BPD; and (c) who would benefit from having such statements as part of their official/formal evaluation of my illness. This statement below is written to include the points raised and not raised during our consultation as well as the decisions and suggested directions we reached. -Ron Price: Statement A, 3/12/‘07 and Statement B, 13/11/‘08. A. Discussion & Decisions From Psychiatric Consultation:30/11/07 1. CONCERNS ABOUT SLEEPING: From my wife‘s point of view I am ―falling asleep all the time.‖ My behaviour was not frenetic and overactive, as it had been before I had gone on this new package of meds. This frenetic/overactive behaviour was the main reason for going on these meds. My behaviour was also somnolent and far too sleepy for a normal person. It was this concern of both my wife and I which led us to feel that a visit to my psychiatrist on 30/11/07 would be useful. The new pattern of sleeping behaviour that has become apparent after eight months on this new medication package(4/07 to 11/07) contains the following details: 1. Alternating periods of fatigue, a slight shortage of breath and sleepiness on the one hand; and energy and enthusiasm for my academic/literary work on the other—often within a few minutes. To put this sleeping pattern in a more precise way, there are several aspects of sleep, sleepiness and wakefulness that I would now like to outline: (i) when I stop working(i.e. stop reading and writing), I fall asleep: (a) in front of the TV, (b) when I am just gazing out the window or (c) when my mind is not engaged to its full extent, as it is in my mental/writing work; (ii) often when I am reading and writing I get so sleepy I have to: (a) go for a walk, (b) take a break and/or (c) have a sleep; (iii) I sleep for: (a) 1 to 2 hours in the afternoon or evening and then go to bed between 1 a.m. and 5 a.m.; or (b) 1 to 2 hours on going to bed at 11 p.m. with my wife and then I wake-up about two hours later, about 1 a.m. In this pattern I get out of bed and stay up for 2 to 4 hours. I then go back to bed for 4 to 6 hours-getting out of bed finally at 10 to 12 noon; and (iv) (a) I am awake until the very late hours of the night, as I indicated in (iii) above, usually until 2 or 5 a.m. Then I sleep until 10 to noon with an hour or two of sleep in the late afternoon or after dinner; (b) My reading and writing tends to be in short bursts adding up to an 8 hour total of literary work per 24 hour period; and (c) I have short bursts of other activities: domestic, social and, personal--adding up to another 8 hours. 2. CONCERNS ABOUT OBSESSIVE-COMPULSIVE DISORDER: I seem to exhibit more OCD, obsessive-compulsive disorder, behaviour: straightening & squaring bits of paper, magazines & newspapers on tables and desks and other forms of
  • 143. tidiness much more than in previous years on lithium—again this is of more concern to my wife. After my description of what I felt to be OCD behaviour, my doctor felt my behaviour in this area was not OCD, only a behavioural abnormality associated with my activity base and style of life. 3. CONCERNS ABOUT URINATION: I am urinating on average every 80 minutes. I calculated this statistical average in September 2007 and the psychiatrist said this was normal/average for my lithium toxicity history. 4. CONCERNS ABOUT DREAMING: I have a nightly dream pattern that is more extensive than ever before in my life. This leaves me with a dense-and-heavy, somewhat disoriented, feeling on waking, a feeling which goes away quickly. Often it takes me an hour or so to get to sleep; I often sleep lightly. On waking I often: (a) stay in bed and go back to sleep, (b) get up and go back to bed and sleep or (c) get up anyway and get a rested feeling after a shower, etc. The doctor said this extensive dreaming was also a normal reaction to the new medication of effexor. 5. CONCERNS ABOUT WEARINESS & SIGNIFICANT OTHERS: 5.1 I get a feeling of emotional and psychological weariness, what used to be popularly called tedium vitae, late at night after: (i) 8 hours of literary work and (ii) a degree of hyperactivity in the previous 24 hour period. In some ways this a somewhat natural feeling given the extent of my literary and academic work. A quiet and low-key death wish usually accompanies this feeling. My psychiatrist was not concerned about this issue since we had talked about it on several occasions from 2001 to 2007, and neither he nor I felt the need to discuss it during this consultation since: (i) my new meds had taken away the blackness associated with this death wish and (ii) the grey feeling and not-black was a big improvement. After many years of the death wish the downside of my condition had been ameliorated and I was not troubled to the same extent as before. I simply accepted the greyness as a normal experience before sleeping. 5.2 The significant others in my life are an important source of: (a) concern to me and (b) relevant feedback. Since I have been on this new medication my wife has come to accept my sleeping eccentricities. We now know what happens as a result of decreasing the level of effexor and I write about this elsewhere in this lengthy account. She has noted that I am given to: (a) inappropriateness of verbal responses in some social situations, and this is still a concern; (b) an increase in OCD behaviour, easy distraction by details or perfectionism--whatever one might call this behavioural pattern--and (c) speeding, a mild degree of rapid cycling, racing ideas or hyper-energetic behaviour when it was not necessary. My wife and I occasionally talk about other/new treatment regimens due to my sleeping so much of the time and me being not my old self, my more hermetic existence—not the meeting-goer I once was. The psychiatrist and I did not discuss these aspects of my behaviour. 6. CONCLUSIONS AND WHERE TO GO FROM HERE:
  • 144. The above served as a basis for discussion and was altered after our consultation so that this statement, draft #2, would include the decisions we arrived at and the items discussed and not discussed, for my record. During our consultation on 30 November 2007(4:30-5:00 p.m.), we decided that the best course of action to take in relation to the above behaviour/symptoms was: (i) stay on the present levels of effexor(150 mgr/day) or (b) reduce the effexor by 37 ½ mgr; then reduce it again by another 37 ½ mgr. until a review with him at my next visit. I went on effexor in April 2007 because I was not sleeping much, had what might be called agitation/insomnia and life was far too frenetic/active. This is not now the case. I am sleeping from 6 to 8 hours every day, but my sleeping patterns are abnormal/erratic/unconventional and I hope to normalise them by reducing the levels of effexor as suggested in section A above. (ii) There may be no change in my sleeping patters, even if I reduce the effexor said the doctor. If I seem to be okay, that is: (i) if I am sleeping well with little agitation, insomnia and not too active, as I am at present; or (ii) if I am not too sleepy as I was at first, then, perhaps, I can go off the effexor entirely after the 2 stages suggested in section A above. (iii) I received 4 prescriptions: 3 for effexor(150, 37.5 and 75 mgr. tabs) and one for sodium valproate. I will get the prescriptions filled when and if it is appropriate and apply them as I decide in the weeks ahead. When additional medications are required I will get a script from my GP not my psychiatrist.--Ron Price 3 December 2007. B. Discussion & Decisions From Psychiatric Consultation:13/11/‘08 The main purpose of this consultation was to review the developments in the last year since the last visit to my psychiatrist on 30/11/‘08. Since that last visit in November 2007, I have reduced my effexor from 150 mgr per day to 112 and ½ in 12/‘07 and then to 75 mgr in 2/‘08, as suggested by the psychiatrist that I do this when and if I felt it was appropriate. Since the effexor was now(11/‘08) functioning at what he called ―a sub- clinical level,‖ he said that I needed to reduce the effexor further. It was, then, decided that: (i) if: (a) the NAVAL level was within the normal range of 350 to 700; (b) the creatinine level was ‗satisfactory‘, (c) the eGFR level for kidney function and (d) the index of liver function was ‗satisfactory,‘ as determined by the eGFR(the globular filtration rate)---all of which would be determined by a blood test on 18/11/‘08---I would then: (i) reduce the effexor level to 37 and ½ mg. for two weeks, (ii) go off the effexor entirely; (10/12/‘08) and (ii) if any problems arose during the above process, I would contact my psychiatrist right away. The most common sleep pattern/rhythm that has developed in the last year has been as follows: (a) go to sleep between midnight and 3 a.m., (b) go to sleep until anywhere from 9 a.m. to 11 a.m.; and (c) then sleep another hour during the day and/or evening. My wife and I have adjusted to this pattern. As my wife puts it: ―when I stop writing at my computer or doing household tasks I often/ immediately get sleepy.‖ This problem was discussed and it was decided that:
  • 145. (a) I would continue with this sleeping pattern until my wife and I wanted to see a change in this sleep pattern.; and (b) if she and I wanted me to have a normal sleeping regimen, that is, from midnight to 8 a.m., we would have to make a greater effort to regularize my pattern into this framework. Finally, my lifestyle has become more hermetic since going on this new medication. I had been a more gregarious person in the past. No decision was arrived at in relation to this ongoing psycho-social problem of a desire for increased social isolation and hermeticism. Other topics were discussed during this consultation on 13/11/‘08 such as: (j) symptoms of BPD before its clear onset in my life in adolescence, (ii) when to come for the next visit and (iii) when my psychiatrist plans to retire, but no notes were kept on these matters. The next visit will be, as this one was, on a needs basis.—Ron Price, 13/11/‘08. Note: the effexor was reduced to 37 and ½ mg./day on 26/11 and then eliminated on 10/12/‘08. No noticeable change in behaviour/symptoms resulted, at least not in the first week, and, thus, there was no need to consult my psychiatrist. Again, I shall report on this in the months ahead. APPENDIX 2: THE 5-AXIS SYSTEM OF DIAGNOSIS 1.1 The diagnosis that has been made in my case, in addition to the several I have been given in more than forty years(1968-2011) is a diagnosis that is standardized according to The Diagnostic and Statistical Manual of Mental Disorders (DSMMD-4th ed‘n-1994) which provides diagnostic criteria for mental disorders. In DSMMD there is a 5 axis/level system of diagnosis that is used and, in my case, axis/level 1 is for clinical disorders that are mood disorder. Axis 3 in this system is for what DSMMD refers 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. In my case, my caregiver, namely my wife, has evaluated me at 61-70 on the numeric scale which reads as follows: ―this adult has some mild symptoms of BPD with some difficulty in social and occupational functioning. Generally, though, he functions pretty well. He also has some meaningful interpersonal relationships." 1.2 Government departments, as I mentioned above, set the bar high for the allocation of a caregiver‘s Allowance and I do not exhibit bad enough symptoms, that is, symptoms below, say, 50 on the scale 1 to 100. Readers wanting a copy of this diagnostic tool can easily find it on the internet. I have appended this tool to this statement in appendix 3 below. APPENDIX 3: THE GLOBAL ASSESSMENT OF FUNCTIONING: A NUMERIC SCALE The Global Assessment of Functioning (GAF) is a numeric scale (0 through 100) used by mental health clinicians and doctors to rate the social, occupational and psychological functioning of adults. 91-100 Superior functioning in a wide range of activities, life's
  • 146. problems never seem to get out of hand, is sought out by others because of his or her many qualities. No symptoms. 81-90 Absent or minimal symptoms, good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns. 71-80 If symptoms are present they are transient and expectable reactions to psychosocial stresses; no more than slight impairment in social, occupational, or school functioning. 61-70 Some mild symptoms OR some difficulty in social, occupational, or school functioning, but generally functioning pretty well, has some meaningful interpersonal relationships.(Note: my caregiver, namely, my wife, assessed/rated my functioning at this numeric level). 51-60 Moderate symptoms OR any moderate difficulty in social, occupational, or school functioning. 41-50 Serious symptoms OR any serious impairment in social, occupational, or school functioning. 31-40 Some impairment in reality testing or communication OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood. 21-30 Behaviour is considerably influenced by delusions or hallucinations OR serious impairment in communications or judgment OR inability to function in all areas. 11-20 Some danger of hurting self or others; or occasionally fails to maintain minimal personal hygiene; or gross communication impairment. 1-10 Persistent danger of severely hurting self or others OR persistent inability to maintain minimum personal hygiene OR serious suicidal act with clear expectation of death. 0 Not enough information available to provide GAF. _____________________________________________________ APPENDIX 4:(Personality Test: completed on 21/1/‘12 PERSONALITY TEST There are many personality tests and the following is a simple one based on Four Temperaments and a theory of proto-psychology. The theory has ancient medical roots and is intended to provide personality traits and behaviors. I utilize it here since my BPD takes place within this personality construct. Sanguine- Overview Easily excited by external influences, reacting quickly, although the impression is often short-lived. There is somewhat of a superficiality, or better said, lack of depth (part v. whole relationship), in the sanguine personality. The sanguine commonly follows others
  • 147. and has little stability as a result. Fickle in ideas, opinions, and resolutions. Changes moods often (from laughter to tears in a matter of seconds). The sanguine rarely internalizes his/her focus and instead devotes attention to the external (his/her appearance, and of others, to beautiful faces, fashions and manners). The sanguine is full of optimism. Sanguine- The not so great Characteristics Vanity and self-complacency, loving the appearance of his/herself and the praise of others. The sanguine is very inclined to flirt, and has a great degree of jealous tendencies. The sanguine cannot be left alone. There is a cheerfulness and love of pleasure that accompany the desire to always have someone around to enjoy life with. The sanguine decision are likely to be the wrong decisions, their undertakings fail easily since they believe success is inevitable and will therefore take it for granted, they are unstable, and they have little understanding of themselves since they rarely internalize conflict. Sanguine- The wonderful Characteristics Everyone loves and knows the sanguine. He/she has the most friends and easily makes new friends. This is the extrovert of the four temperaments. The sanguine is extremely friendly, pleasant, and willing to accommodate. Is often found entertaining others, is compassionate towards others, and is graced with the gift of calling others out on their faults without bringing humiliation or displeasure. Very virtuous. Rarely shows resentment or defiance. Wishes the best for everyone. Melancholic- Overview Like the Sanguine, the Melancholic is also easily excited by things. However, unlike the Sanguine, the initial reaction of excitement is weak, but the impression remains long and grows stronger by subsequent impressions of a similar nature. A person of this temperament is inclined to deep, thoughts and reflection, dwelling the past, looking ahead to the future, is very profound, finds meaning in just about everything, and is not satisfied with the superficial. The melancholic is driven by laws and principles. The melancholic is most comfortable alone, and in silence. He/she is very introspective and always sees life from a serious perspective, often feeling burdened and brought down by temporal affairs. Melancholic types are commonly passive, reserved, irresolute, despondent, lacking courage, slow in thought and speech. Melancholies despise the lime- light, and would rather withdraw and let others receive recognition, even when they are praise worthy. Melancholic- The not so great Characteristics Easily falls into mental distress and this can be extremely intense. The melancholic, more than any other temperament, has keen awareness of moral right and wrong, and has a deep longing for morality. They are inclined to despair, intense expressions of grief, and occurrences of depression. This can result in self-pity, and he/she may become a burden to friends and family. He/she can also lose confidence in others, specifically superiors; there is a loss of trust and respect when the melancholy becomes aware of a fellow man's weaknesses and faults. The melancholy vehemently desires justice, and forgiveness of offences is hardly an option. He/she is suspicious, lacks trust in people and fears that everyone is out to get him/her. He/she is pessimistic about everything.
  • 148. Melancholic- The wonderful Characteristics Loves solitude and is often productive in solitary hobbies encompassing the fine arts, liberal arts, crafts, writing, analytics, drama, contributing deep and profound thoughts and ideas to poetics, philosophy, science, and legislation, etc. There is a joy and a relaxation that results in the melancholic devoting time to these activities. Melancholies are excellent counsellors to friends, encouragers, give great affirmation when necessary, they are trustworthy and genuine. They are willing to make extreme sacrifices for the sake of others. The above typology or characterization is a useful one in providing an overall context for the expression of bipolarity in my life and my life with my wife. The above two personality types are very explanatory and I have tried to place them in the context of my life from childhood to late adulthood. APPENDIX 5: VISITS TO DOCTORS MEDICAL INFORMATION SHEET No.12(go to diary>bipolar>medical>blood test 6-2013-in computer directory) PREAMBLE:Part 1 The following two preambles outline: (a) what this Sheet No. 12 provides, that is, information that is kept for: self, doctors and relevant others. The record of sheets 1 to 11 was begun at age 55 on my early retirement and on moving to Tasmania from Western Australia for a sea-change. Sheet No. 12 is for age 68.4-69.4(to end of 2013), (b) what Sheet No. 11 and others provide, namely, my medical record back to the age of 59. See my personal Medical Files(Section E.2.1 and 2.2) in my brown brief-case under my desk for all blood test results before the present. Not all history details are kept on file for this period 1999 to 2013, just a working base for practical use, and (c) a summary of my recent experience with each of my doctors. 1. I saw Dr Richard Ayling in 2005 in L‘ton at the Summerdale Medical Centre(63447177) 2. I stopped seeing Dr E. Ratcliffe at 155 George Street(63312122) in 2009. Dr Johl-- private: 63344866 at 166 St. John St. 2 days-Tu/Th-private on 0408128700. He is at the LGH 3 days a week: M,W, & F—63487111. There are two other psychiatrists at the LGH-options from 2009-2012. I have never seen any of these doctors. 3.I began seeing the psychiatrist Dr George Hyde in April 2012, 166 St. John St.- 63340188, a private practice. Saw him 4 times in April to August 2012. 4.1 I began seeing an optometrist named Donald in 2012, and Frances in 2013. I will get a letter in January 2014 to have my next eye-test in George Town. This will also be a test for glaucoma and the development of my cataracts. I have 2 cataracts in the right eye, and 1 in the left(age-related).(tel # to book a test: 1300 139363). 4.2 Private Health Care with CBHS is cheaper than Dept of Health and HS. My glasses were fixed on 10/9/‘12 for free, that is, the frame and screws. Options:
  • 149. (Kiah=receptionist). Keep the glasses(frames and lens) I‘ve got until I sit on them. When I‘ve sat on them, then come in with Chris and get a new frame(covered by medical benefits)(CBHS). Before getting the new frame, discuss the question of a new lens $319 or $379(29/1/‘13) with clip-ons for $300. The lens mentioned above takes away the glare and they have a hard-coating; CBHS probably covers 50%. PREAMBLE: Part 2: 5. I began seeing the renal physician Dr Rajesh Raj on 16/10/‘12; I saw him again on 27/11 at 2:20, and my next appointment is on 21/5/13 at 2 pm after a blood test in early May 2013. Dr Raj advised that: (a) I see Dr Monsaur in his private rooms; (63315800-26 Lyttleton St); (ii) I had a constriction in my urethra due to an enlarged prostate, and that was why I needed to see the urologist, Dr Monsour, and (c) I need to have a blood test circa 7 May 2013 at Launceston Pathology(71 Frederick St-63343636). I will now see Dr Raj twice a year. 6. My 2nd visit with Dr Michael Monsour was on 15/2/‘13; the first was in 2009. Ultrasound and CT Scan (Computed Tomography) are two of the most widely used medical imaging techniques. The techniques use different principles to generate an image for diagnostic purposes. The results of my CT scans and ultra-sound, done in November 2012 at Regional Imaging Tasmania (RIT), the major provider of medical imaging services in North and North-West Tasmania, and requested by my renal physician, Dr Rajesh Raj, are as follows: 1.1 I do not need a cystoscope(with gel) up my urethra to check on the multiple-and- simple cysts on my kidney, and the moderate thickening of my bladder. 1.2the degree of the constriction in my urethra due to my enlarged prostate, an enlargement Dr Monsour first investigated in 2009, is as follows: (a) it is slowly enlarging, and (b) whatever problem arises depends on whether the process of enlarging grows inward or outward thus affecting the size of the urination-hole. 1.3 It will not be necessary for me to have a reboring which is a surgical procedure with its dangers of infection and tearing. 1.4 I got a script for a medication known as duodart. I will take 1 tablet/day and it is taken ½ hour after eating at the same time every day. This medication may have side- effects, and if they are bad enough, for example, dizziness and/or light-headedness, then stop the duodart. I took my first pill on 17/2/‘13. This may take a few days to integrate into my seroquel and effexor medications, and my vitamin & mineral daily package. 1.5 I made an appointment to see Dr Monsour again on Thursday 13/6/‘13 at noon. The Medicare costing schedule is as follows: $145 for the first consultation with a $72 rebate, and $75 for the 2nd consultation in June 2013 with a $35.90 rebate from Medicare. Dr Monsour will send Dr Z a copy of his recommendation. 1.6 I urinate, on average, once every hour during the day, and get up 3 to 4 times a night. I am not having any discomfort urinating; the new meds should help me empty my bladder of the 90 ml that are there even after urinating. 1.7 My MCKD(moderate chronic kidney disease) phase 3 is not causing me any pain and
  • 150. there is no blood in my urine or weight loss. Therefore no serious problem is indicated. If the constriction in my urethra increases in size, though, there is a risk it could affect my kidneys and, therefore, my MCKD phase 3. 1.8 I need to clean my foreskin daily and dry it if possible to be sure that no infection occurs in that area of my penis. 7. I saw Dr Jane Zimmerman for a complete medical on Monday 7/1/13(2:00), and I will have another one on or about 7/1/‘14. I will have a hearing test on 3 April at 8:30 followed by a visit with Dr Z at 9 a.m. My next blood test is on 11/‘13 followed by a visit to Dr Z one week later.(this appointment has not yet been made). 7.2 Dr Jane Zimmerman: Discuss the following on 3 April: 1. Dr Monsour: 15/2/‘13; 2. hearing test-result. 8.1 Dr Barry Gilbert gave me referral on 26/9 for me to see the Renal Physician, Dr Raj Rajesh. He faxed through to Dr Rajesh‘s rooms and I saw him on 16/10/‘12 at 3:00 pm. $200 up-front and $125.90 back from Medicare(I gave Mandy my bank details)- 63344188 at St. Luke‘s, 16 Lyttleton St in L‘ton 8.2 On 13/12/‘12 I discussed the results of a hearing test. He said: (a) come back for a test in 3 months. I have made an apt on 3 April at 8:30, (b) I may have an acoustic neuroma(see info sheets); I will decide whether to have an MRI scan after next visit on 3/4/‘13 with Dr Z; and (c) hearing in right ear is fine, left ear significant hearing loss. A. ITEMS TESTED IN THE BLOOD: The information below, the record of my: (A) blood test data, (B) non-blood test data and (C) other data(current and historical) is for my use in determining: (i) when to do the next tests, (ii) what to discuss with my GP, Dr Jane Zimmerman, Dr Dawson or Dr Barry Gilbert in George Town at my next visit (63824333-Box 163: twice a year as of 2011). Chris Price‘s mobile is: 0427755093 and I need this number occasionally for medical purposes. 1. Triglycerides: see blood test file OMACOR-the best fish oil-10/4/12(too expensive- 6/‘12) 2. Cholesterol*(fasting required) 2.1 LDLs and HDLs-see blood test file; 20 min. aerobic type walking every day(begun ASAP) COPD-30 min. non-aerobic walking every day(begun 1980s); Discussion of Cholesterol in 2004/5:(a) medication-lipitor—decided: (i) it was too expensive($60/month & only if my reading is 7.5 & over) and (ii) take it when I am much older & over 7.5; (b) foods discussed with Dr. Ayling to lower cholest; (c) aerobics exercise required to lower LDHs; (d) Dr. R said I should aim for an overall reading of 4.4 or below. To achieve this I should: (i) walk 1/2-1 hour per day and puff for 20 minutes and (ii) watch diet--more avocados & oatmeal & less cheese, bickies & sugar. THE lithium BLOOD TESTS WERE DISCONTINUED in APRIL 2007--That information is now archived.
  • 151. Blood Tests Below Were Continued After April 2007: 3.(a) For Kidney Function: The creatinine and urea levels are indicators of KF. *1. Creatinine: see blood test results 1.I had an ultra sound(US) for renal function...on 24/11/08. Creatinine readings here should be less than 106; creatinine levels are high. I am waiting for a letter from an urologist for possible medication. Frequent urination started in 2002/3. I got some internet notes on eGFR(see Medical File Section D: BPD) (eGFR=33, 37, 32-on 31/10/‘12) Dr. Z said (a) I have a ―phase 3 moderate chronic kidney disease(MCKD)‘& (b) phase 5 was a crisis state and I would have to go on a dialysis machine. Drink 2 litres of water per day. 2.Saw a renal physician, Dr Raj(16 Lyttleton) on 16/10/‘12 before my 2nd visit to the urologist(first visit on 9/2/09). I had a range of blood tests on 16/10 and had an X- ray(11:15 on 14/11/‘12) and ultra-sound test on 14/11/12 at 11:30 to noon at St. Vincents(3 to 4 glasses of water; 300 ml of urine)(Dr Raj said I do not empty my entire bladder of urine) I saw Dr Begum on 27/11/‘08 and she advised, as a result of the ultrasound-X-rays, I had in L‘ton, that I: (i) collect my urine from 2:30-1/12 to 2:30-2/12/‘08;(result: 2.89 litres collected) (ii) have a blood test on 2/12—for urologist in L‘ton: Dr. Monsaur at LGH Admission Office: 63487391. I collected my urine again on 7/09: 3 litres & 24 times. This specialist clinic sent me a letter to discuss my kidney function, my thick bladder and the multiple cysts on kidney with Dr. M.J. Monsour. If there is an obstruction (cyst=kidney/thickening=bladder), it may have to be removed or it may not be serious. 3.The job was done at the LGH at their specialist clinic. I call 63487111 and ask to speak to the specialist clinic. Dr Mike J. Monsour on 2/2/‘09 gave me a FUB. See above for Dr Monsour. 4.Signs of MCKD problems to cause me concern are: pain, blood in urine, weight loss. If none of these I should not worry about my MCKD. The 1st signs of serious, acute or chronic renal failure/problem are: (a) creatinine level test in blood; (b) an early prostate problem, and (c) if I have trouble urinating. Since I urinate every 30 to 80 minutes I do not have an acute/serious problem. 4.Urea:-see blood test results 5.For Sodium Valproate and Effexor-see blood test results; NAVAL-discontinued in April 2012. Effexor-75 mg/day -I do not keep a record of my scripts as of September 2012. (c) Other Blood Tests For Other Problems: 6.Liver: The results for each year of this annual blood test beginning in 2003 were all okay. Do a magnetic resonance imaging test, if there is a problem. Had a liver function test(LFT) on 18/11/08. Have one every year from 2011 onwards. 7. Haemoglobin(Red Blood Cells)-see blood test resultsRange: (130 to 175)(or 140 to 180)( or 4.8mmol/L to 5.2)( or 8.7 to 11.2) ….154-28/11/‘11; 134-22/4/‘12: at Red Cross Blood donation
  • 152. 8. Blood Pressure 130/80=average; 142/79-22/4/‘12; 119/74-7/10; 149/89-11/09 157/95 on 23/7/‘12; 150/90 & 147/95 on 15/8/‘12. I do not have high blood pressure; decision on 15/8/‘12 9.Type-2 Diabetes: (blood glucose)4/05(4.7), 10/06(5.2), 12/07(4.5). Test is done with cholesterol every 12/mo. Tests: 12/08:-5.1; 1/10-5.0; 10/10-5.2 fasting required-result needs to be below 5.5. It was 5.3 on 10/‘12. 10. Thyroid Tests: twice in 2004, and annually from 2005. 11. Vitamin D-blood test in 10/10. Result: low-take Vit D-supplement. I have been taking it since 10/10(400 IUs) and (1000 IUs). Blood test results in 11/11-okay. Started to take 1000 more IU as of 1 July 2011.(get blood-test results on 31/10/‘12. Should be more than 74; I‘m 84 on 31/1o/‘12 12. Vitamin B12; should be ‘38 to .50; I‘m .45. 13. Hepatitis-C-I don‘t have it. Dr Gilbert-8/12. 14.1 Medications: taken every day as of February 2013 effexor-75 mg-in morning; seroquel-75 mg- in evening; duodart for prostate-begun 17/2/‘13. 14.2 Vitamins and Minerals: taken every day as of February 2013 A. magnesium-150 mg-in evening B. fish oil-1000 mg, vit D-1000 IU multi vit, , zinc-25 mg, +V, aspirin- 100 mg B.-in morning B. ITEMS TESTED NOT-IN-THE-BLOOD: Much of the information in this section is now archived and is not required for on-going medical information and visits to doctors. 1.The Prostate: -see blood test results- (ng/ml=nanograms/millilitre)--result-OK as of 5/1/‘12--*next FUB—on 13/2/13 with Dr. Monsaur. (PSA 1.3 on 31/10/‘12, should be less than 5.9 I will edit the following paragraph when time permits 2.Wax Build-Up In Ears: Use ear drops: cerumol: keep putting in drops once/month, if useful. Don‘t use drops from 2009(circa) and following. Syringe dates:10/01, 10/02, 15/03 and 17/03. No syringing: 2003 to 2011. Syringed on: 11/4/‘12.(10 drops once a month, 15 minutes laying on bed to get drops into ear-smelly). Had hearing test on 13/12(result?) 3. Chest X-Ray: Result of test in June 2001: diagnosis of chronic obstructive pulmonary disease; elasticity of lungs is less than it should be; need to breath more deeply, more vigorous exercise. Such exercise was begun in May 2003. Stopped in August due to sore foot. Last chest X-Ray: 2004 and 2012. No problems. October 04-okay: no significant change from 6/01; discuss at 12/05-no need for X-ray;
  • 153. discussed again at visit in 10/06, 12/07 and 1/09. No need to discuss again unless some new problem arises with breathing/lungs. Spirometry test on 19/12/07-3:30 Result: mild asthma: puff-ventalin-prescription-once/day. Got results sheet on 6/3/08. Discussed with Kylie: discussed (a) use of spacer and (b) whether to get ventilin & inhaler. Decided it was not necessary because I was doing the buteyko exercises. 4. Check my moles/warts/sores on scalp/small growths for cancer and to get rid of them if annoying. 2001:Sore on neck was not carcinogenic; small growth on arm not cancer. 3/2002-3/2004-no problems. Wart on forehead: cut off:-3/12/04. pay: $10; stich out on 8/12/04. Discuss growth on arm on 20/1/11 & got script for fixing it. Alternative: (i) buy wort paste, (ii) put clear nail polish around paste, (iii) put waterproof tape around nail polish, (iv) leave for 4/5 days; and (v) then repeat until wort is gone. Dr. Z. will do a nitrogen burn-off on 11/11/‘11 at 1:30(done by Dr. Bailey-Smith on 30/6/‘11). I said I was prepared to live with the problem of possible satellite warts developing after burn- off. I took off the mole with a band aid on the mole for 1 week-5/1/‘12. 5. Complete 'Medical:' 6/1/‘13-all okay. Information on 1/10: weight: 230 lbs/105 kg; height: 181 cm; waist 46 ½ inches or 118 cms; blood pressure is always good. All other pressure tests on stomach, chest, feet, back, etc.-OK. Next complete medical on 7/1/14. 6.Check for bone density. Walking, aerobic and non-aerobic, is enough. March 2003: okay. 2/05 Bone density is an indicator of osteoporosis and fracture risk-have a test at age 70. Treadmill exercise 2005-2007. Take Vit D and calcium. 7.1 Sore feet and other podiatry problems began about August 1, 2002. Need to wear pad under foot/inner sole and not stress my foot until it is better. My foot was okay by 6/04. I tried the treadmill beginning in 04/05, but lost the desire. The podiatrist in Launceston I went to was Daniel Lightfoot: 63319568. He suggested 5/05 that: (a) my wife cut my toe nails. He is at 18 Brisbane Street. No more appts were required. See podiatry file. 7.1.1 I got a referral to see Podiatry North(63365155) from Dr Z on 28/6/‘12 and I went there and saw a podiatrist in 9/12 and 12/12 for nail-cutting to prevent ingrown toe-nail. The chilblain went away by the summer. I could buy a circulation booster machine because my problem may be simply ―skin circulation.‖ I will get a letter from podiatrist) around 11/5/‘13 to see her again. New shoes-no; cream on foot-yes, item from chemist for chilblain-no.(see podiatry file) 7.2 Plantar Fascitis: pain under the heal of foot(see internet info) from 9/7/08. After 6 weeks I bought a heel pad on 26/9/‘08 for $40; got a pad from Viv in 8/08. Made list of treatments: ice pad, rest, support, anti-fungal. If more help is needed go to: Int‘l Show Store on Bathurst St. for a high density foam pad. Talked to Dr.Z and she said (a) the problem could last for 1 year and (b) keep going for walks. All ok by 12/09. 8. Eucalyptus/tea-tree oil is good for fungus. I have no fungus on 12/12 but signs exist that I have had fungus. Discussed with podiatrist. Have used anti-fungal cream off and on from 10/06, & daily from 8/07 to 10/08. The problem is also due to wetness and age; therefore keep foot dry. I have used eucalyptus oil on both big-toes. Anti-fungal powder is good, buy fungal cream & eucalyptus oil is enough. Soak in vinegar and water every two weeks. Got script for lamasil every day(30/6/11) in toe-nail cracks; got antibiotics for blood due to cutting of toe-nail(30/6/11). 9. crotch itch with cotton balls; wash with hot cloth and dry with small towel. Use ointment(NEAT 3-B action cream) when there is an itch. 10.Breathing: got adenoids out
  • 154. when a child?; buteyko, asthma(ventilin); Fess nasal spray(75 ml) cleaner/lubricator-not necessary. *11.Flu shots: Had a flu shot in 8/07, 6/08 & 4/11. This flu shot should be done annually. The last one was done on 28 March 2012;(next 3/‘13) I got a letter. The routine: Take script to chemist; take container from the chemist back to Dr. Z‘s receptionist. Dr.Z had no record of my having a flu shot from 1999 to 2007. We decided to have a flu shot annually especially. 11.1 Had a pneumonia shot at age 65 on 28/10/09 & I will have it again at age 70—that is in July 2014. Not required after that. 12. Gave Dr. Z a Donation of My Brain form 12/07. *13. Faecal occult blood test. Got 3 containers on 9/2/09 for faeces for three days(Tu, Th & Sun). Took them to pathology separately and waited for results. Everything is okay. Do this test annually. Last one on 21/5/10. Next one: April 2014. Got kit from Dr. Imran Aslam on 11/4/12)(every 2 years?*) 14. Reflux/gastric-acid in stomach. Check the foods I have eaten and see if there is a relationship between the foods and the acidity, 9/2/09. No relationship noted by 20/2/09. 15. Swelling of knees in 1950 due to virus or scarlet fever; pneumonia 1946- 50(2). 16. Stomach cancer-pin-prick test-kit from chemist. Chemist had no kit on 20/2— only in U.K.Dr Dawson said there was no such kit on 12/12. 17. Immunization shots: (a) typhoid: script($44.05-paid-pd)shot 11/3; (b) triple antigen: $37(pd-at Anne St.)-tetanus booster(last one in 2000); next one in 1/‘1. This also covers whooping cough & diphtheria; (c) anti-biotics for diahorrhea & vomiting on 9/4 & (d) hepatitis A&B: ($70x3=$210Pd)18/3(11:20),25/3, 9/4/09(twinrix) & 9/4/10(*)(done) Got a letter to cover my medications to take to Israel. Polio booster-$50 & flu shot on 12/3($53.50-pd). Next tetanus-booster in 1/‘21. 18. Had a test for benign vertigo. It had gone away by 24-9-09 after 2 or 3 days of this dizziness. I had this same problem several years ago and did a ―movement of the finger from side to side test...standing up and sitting down.‖ 19. Folliculites: got a script for doxy on 15/8/‘12(take with food. Hamilton Bath Oil-Dr Gilbert suggested this and Chris got a medicated soap. She also advised I use: (i) Gentle Wash in the shower, and (ii) Skin Lotion after my shower. I have rosacea on my face. I went back on 26/9/‘12 and got another script, but Chris thought it better not to take it. Chris bought pHisohex on 12/12/‘12 to use in shower. Got another script for Eryc on 13/12 for folliculitis; got pHisohex at chemist on 6/12/‘12; I got the script for Eryc on 15/12/‘12 from Dr Dawson. I decided in 1/13 not to renew the script. I will now just watch and wait to see how the pimples develop. 20. Keep track of other illnesses/diseases/problems that arise from time to time due to (a) personal experience or (b) things I hear about from people or in the media. C. OTHER: C.1.1 Dr. Ratcliffe and C.1.2 Brenda Gunst C.1.1 Stopped seeing him in 2009. C.1.2 -28/6/‘12-holistic interview and saw her again on 10/8/‘12. C.2 Dr Hyde: See my statement on BPD; saw him 4 times from April to August 2012; 63340188; 166 St John Street C.3 Other Medical Information(for use when filling out forms) 1. last hospitalization-May 1980. 2.COPD/emphysema-2001-diagnosed on this date. 3. frequent urination: every 80 minutes as calculated in 8/07. 4. depression: 1963 to 1978- periodically before BPD diagnosed in May 1980. 5. testosterone injections from 9/98 to 2/99. Last Updated On: 17/2/‘13. APPENDIX 6:
  • 155. THE STIGMA OF SILENCE: AN ARTICLE BY GLENN CLOSE The following comments come from an article entitled: Mental Illness: The Stigma of Silence by Glenn Close(October 25, 2009, The Huffington Post) I have slightly edited the following post at the website: www.huffingtonpost.com.--Ron Price, Tasmania 1. Glenn Close is an Emmy, Golden Globe and Tony Award winning actress. This is her book and to her mental illness was no stranger. She writes that from Alex Forrest in Fatal Attraction to Blanche Dubois in A Streetcar Named Desire, to Norma Desmond in Andrew Lloyd Weber's Sunset Boulevard she had the challenge and the privilege of playing characters who have deep psychological wounds. Some people think that, in these movies, Alex was a borderline personality and that Blanche suffered from post- traumatic stress disorder. Everyone knows that Norma is delusional. 2. Glenn writes that she had the challenge of confronting the far less entertaining reality of mental illness or mental distress in her own family. Her sister suffered from bipolar disorder and her nephew from schizoaffective disorder. There has also been a lot of depression and alcoholism in her family. Traditionally, she says, no one ever spoke about these problems. It just wasn't done. The stigma was and still is toxic Close emphasizes. Like millions of others who live with mental illness or mental distress in their families she has seen what these people have to endure. It is often the struggle of just getting through the day. It is also the hurt caused every time someone casually describes someone as "crazy," "nuts," or "psycho". 3. Even as the medicine and therapy for mental health disorders have made remarkable progress, the ancient social stigma in relation to psychological illness remains largely intact. Families are loath to talk about it and, in movies and the media, stereotypes about the mentally ill still reign. Whether it is Norman Bates in Psycho, Jack Torrance in The Shining, or Kathy Bates' portrayal of Annie Wilkes in Misery, scriptwriters invariably tell us that the mentally ill are dangerous threats who must be contained, if not destroyed. It makes for thrilling entertainment. There are some notable exceptions, of course -- Dustin Hoffman in Rainman, or Russell Crowe's portrayal of John Nash in A Beautiful Mind. But, more often than not, the movie or TV version of someone suffering from a mental disorder is a sociopath who must be stopped. 4. Alex Forrest is considered by most people to be evil incarnate. People still come up to Close saying how much this character terrified them. Yet in her research into her own behavior, she only ended up empathizing with this character. She was a human being in great psychological pain who definitely needed meds. She consulted with several psychiatrists to better understand the "whys" of what she did and learned that she was far more dangerous to herself than to others. The original ending of Fatal Attraction actually had Alex commit suicide. But that didn't "test" well. Alex had terrified the audiences and they wanted her punished for it. A tortured and self-destructive Alex was too upsetting. She had to be blown away. So, the director and producer went back and shot the now famous bathroom scene. A knife was put into Alex's hand, making her a dangerous psychopath. When the wife shot her in self-defence, the audience was given catharsis through bloodshed, Alex's blood. And everyone felt safe again. The ending worked. It was thrilling and the movie was a big hit. But it sent a misleading message about the reality of mental illness/distress.
  • 156. 5. It is an odd paradox that a society, which can now speak openly and unabashedly about topics that were once unspeakable, still remains largely silent when it comes to mental illness/distress. Breast cancer and even Aids engage political and health care leaders from every part of the globe. Illnesses that were once discussed only in hushed tones are now part of healthy conversation and activism. Yet when it comes to bipolar disorder, post-traumatic stress, schizophrenia or depression, an uncharacteristic coyness takes over. People often say nothing. The mentally-ill seem to frighten and embarrass the general population. The mentally-ill are marginalized by the people who most need their acceptance. 5.1 What mental health needs is more sunlight, more candour, more unashamed conversation about illnesses that affect not only individuals, but their families as well. Our society ought to understand that many people with mental illness/distress, given the right treatment, can be full participants in our society. Anyone who doubts it ought to listen to Kay Redfield Jamison, a psychiatry professor at Johns Hopkins, vividly describe her own battles with bipolar disorder. 6. Over the last year, Close has worked with some visionary groups to start BringChange2Mind.org, an organization that strives to inspire people to start talking openly about mental illness/distress, to break through the silence and fear. That group has the support of every major American mental health organization and numerous others. Close has no illusions that such an organization will serve as ―a cure‖ for mental illness/distress. Yet she is sure it will help society along the road to understanding and constructive dialogue. It will help deconstruct and eliminate stigma. 7. The World Health Organization estimates that by the year 2020 mental illness and its distressing symptoms will be the second leading cause of death and disability. Every society will have to confront the issue. The question is, will society face it with open honesty or silence, with a slow and gradual destigmatization process as has happened over the last two decades or a faster one in the next decades, say to 2044, when I will be 100 years old. APPENDIX 7: THE DAVINCI METHOD 1. The following email and comment was received in two parts from Garret LoPorto, the author of The DaVinci Method, on Friday 13 November 2009 and 5 February 2010, respectively. He wrote the first part of this message, as he said, inspired by Pearl Buck 's poetry. While the sentiments in his email below are a little over-the-top as they say Downunder, there is a core of truth in the tone and texture of what LoPorto has written. LoPorto sent this email to a very wide range of people, some BPD sufferers and some not. I include parts of these emails in this appendix to my story for its value in conveying some of the core experience of those who suffer from BPD. 2. The BPD gene, so the argument goes, affects the brain's relationship with dopamine. This difference causes one to crave stimulation just to feel alive and makes one's moods unstable. The key to success when one has BPD is learning how to channel all that creative energy into taking intelligent risks. People with BPD are brilliant as well as not- so-brilliant risk takers. LoPorto states that 10% of the world has a special temperament,
  • 157. what he calls the Da Vinci temperament. The Da Vinci temperament has very low self- repression. This sensation-seeking temperament is shared by virtually all great visionaries, pioneers, entrepreneurs, artists and innovators. All of the impulses and creativity that the subconscious mind generates come to surface in the conscious mind and have to be dealt with. Hypomania is actually a very powerful asset that has helped some of the world's most successful people achieve their success. In retrospect I feel it has helped me over the decades. Hypomania allows one to solve difficult problems easily and it maximizes the energy available for the task at hand. It is a condition similar to mania but less severe. 3. The symptoms are similar with elevated mood, increased activity, decreased need for sleep, grandiosity, racing thoughts, and the like. However, hypomanic episodes differ in that they do not cause significant distress or impair one's work, family or social life in an obvious way while manic episodes do. Hypomanic people tend to be unusually cheerful, have more than ample energy and need little sleep. Hypomania is a pleasurable state. It may confer a heightened sense of creativity and power. However, hypomania can subtly impair a person's judgment. Too much confidence can conceal the consequences of decisions. Hypomania can be difficult to diagnose because it may masquerade as mere happiness. Hypomania is a feature of three mood disorders: bipolar I, bipolar II disorder and cyclothymia, but it can also occur in schizoaffective disorder(SAD). I was diagnosed as having a mild SAD in the last months of 1968 while I was institutionalized in a large psychiatric hospital in Whitby Ontario. Whatever hypomania I had at that time, if indeed I had any, it affected my productivity. 4. People with BPD have a keen sense of intuition and the states of their minds are extreme. They are prone to experiencing periods of tormenting confusion followed by moments of great clarity. When the clarity comes in it brings with it bursts of creative genius and a spontaneous awareness of exquisite solutions to problems that previously seemed insurmountable. The only way a person with this disorder gets to have that amazing insight, that paradigm shift of thought, that out-of-the-box solution is to engage in one‘s project and encounter the frustrating complexities of one‘s current approach to achieving its goals. 5. As LoPorto says ―Oprah Winfrey's grandmother gave this disorder, this temperament, this gift, to her. She has never forgotten it and says it probably saved her life. Sir Richard Branson's mom gave it to him and it has propelled him to amazing heights. Thomas Edison's mother gave him this gift, too, and he said it was the making of him.‖ This gift used to be very rare, difficult to give and nearly impossible to talk about because people simply didn't have any way of saying what it was. Now people do. 6. Dear Ron, You are amazing. Many do not understand your bipolar nature but you can rest assured that the bipolar experience is no more than this: a heroic soul born inhumanely sensitive, desperately in need of true connection. To you---a touch is a blow, a misfortune is a tragedy, a joy is an ecstasy, a friend is a lover, a daydream is a premonition, strictness is suffocation, and completion is death. Added to your brutally sensitive soul is the overwhelming need to heal, create, and transform. Without the outpouring of honesty, the creating of music or poetry or something of meaning your very breath is cut off.
  • 158. You must create, must pour out your entire being in each and every encounter. By some strange, unknown, inward urgency you do not feel truly alive unless you are risking everything through your divine expression. Thank you for having the courage to create, to transform, to be in a way other souls don't. For without your courage and your light the world would grow listless and dull and the rest of us who are like you would not have your courageous acts to inspire our own. Rock on, Garret LoPorto Author of The DaVinci Method www.DaVinciMethod.com 7. LoPorto sent the follow circularized message to me on 5 February 2010: There are ideas, beliefs and habits that spread from mind to mind, installing and running themselves in your thought process without your permission. They can: (a)hijack your mind and your life and rob you of your dreams and your freedom? (b) silently upset, hurt and cause you, in turn, to hurt your loved ones? (c) make you think in ways which are unnatural and depressing? (d) cause massive frustration and unnecessary failure in your life? and (e) these viruses are the root causes of ADHD, BPD, compulsions and obsessions as well as addictions and depression. LoPorto deals with these ideas. So must I in my life and this BPD story will continue to tell of my successes and failures in this part of my life-narrative. APPENDIX 8: MEDICAL INFORMATION FILES: FOR RON PRICE TABLE OF CONTENTS Preamble: These 5 files assumed the form they now have(1/1/‘11) by stages in the years 1999 to 2010, the first decade of my retirement from FT(1999), PT(2003) and casual/volunteer work(2005). I have included this table of content for these 5 files to provide a wider perspective on my BPD. These files are now labelled: Sections: A, B, C, D and E for convenience of storage and retrieval. They are kept in my brown brief-case in my study under my desk to the right. This brief-case is given the single label: Medical Files. Sections A and B are in a single 'fold-over file;‘ sections C, D and E are in separate A-3 files. In my computer directory go to: everyday>bipolar>medical>CONT MEDFILE-A- E. Additional files with medical information are kept for: (a) the mental illness forums I post at and interact with others, (b) mental health information and (c) general health issues. These additional files are found in separate arch-lever and 2 ring binder files on the book shelves and on the floor in my study here in George Town Tasmania.-Ron Price, 1/1/‘11. Section A: 1. Funerals and Burials Info 2. Bi-Polar Illness(now in Section D.1 to D.11)
  • 159. 3. Visits to doctors: Info 4. COPD: Chronic Obscructive Pulmonary Disease 5. Cholesterol Problems & Triglycerides Section B(i) 6.1 Anne Street Clinic Information 6.2 Prostate Cancer Information 6.2.1 urination Section B(ii) 7. Cancer: General 7.1 Stomach 7.2 Colon/Bowel Cancer 8. Chris Price 8.1 Breast Cancer 8.1.1 Chris‘ Symptoms 8.2 Advice from Chris for My Health Section C: 9.1 Brain Donation 9.2 Organ Donation 10. Male Menopause 11. Medical Cards 11.4 Medicare Information 12. Bidet Toilet Seats 13. Seniors Card 14. Dentist Information 15. Disability: Definitions/Info/Transport Access Sticker 16. Real Age 17. Diabetes 18. BMI(Body-Mass Index) 19. Foot Problems Section D: Bipolar Disorder: 1. Lithium 2.1 BPD Genetic Project 2.2 Luvox 3. Sodium Valproate 3.1 Venlafaxine(effexor) 3.2 Neurotransmitters 4. Bipolardisorder 4.1 General Information 4.2 My Statement: 33,000 words(10/‘09) 4.3 BPD Research 5. Dr. Eric Ratcliffe: Psychiatrist -Consultation Info and Kidney Function 6. Dr. Jane Zimmerman-GP 6.1 medical letter for overseas 7. Other Experts 7.1 Dr. Ayling & 7.2 Alternativies 8. Dr. Christine Price 9. Blood Test Results: Archive(2000-2005) 10. Creatinine Info. 11. Spirometry Tests/Info
  • 160. Section E: Self-Maintenance-Medical File 1.1 and 1.2…Bi-Polar Story: In 2/08: two copies 2. Blood Test Results: (a) archival(2005-2008) & (b) current: eGFR & spirometry/urology/kidneys(2005—8) 3.1 Buteyko Information 3.2 Breathing 4. Current Medical Information -Sheet Number 7 5. Script for Asthma: cancelled 1/08 6. Giving Blood: Red Cross Info 6.1 Blood Pressure 7. Exercise Program Sheets 7.1 Sleeping Record 7.2 Benign Vertigo 8. Special Prayer Package 9. Self-Maintenance File(1) APPENDIX 9: SOME RELEVANT POEMS: 1. A STRONG CONSITUTION? This afternoon, in mid-summer here in Tasmania, I sat under a tree near the beach at Low Head on Bass Strait and read Roy Campbell: A Critical Biography by Peter Alexander.(1982). This South African poet(1901-1957) had, according to Alexander, a magnificent constitution. According to the famous psychiatrist, Laurens van der Post, Campbell was a man "born on fire." He could only live by burning himself out: drinking much and eating and sleeping little. It is difficult, it seems to me, to determine what, in fact, is a 'magnificent constitution.' Have my history of manic-depression, the slow development of a mild emphysema, a certain psychological fatigue as I came into my sixties and, perhaps, several other illnesses like pneumonia and some polio-like disease contracted in my childhood, had the effect of weakening my constitution? Is writing millions of words a sign of a strong constitution? I don't know, but I do know I have experienced varying degrees of burn-out several times in my life. It would appear that, like Campbell, burning myself out was part of my central life experience, although the causes of the burn-out were quite different. It would appear that, in this the early evening of my life, I have learned to live without burn-out and its tragic consequences. -Ron Price, Pioneering Over Four Epochs, 22 January 2002. A million impressions, impressed themselves over these several epochs in the last half-century,1 pressed themselves upon me and, as Keats said,2 annihilated me.3 I surrendered, lost myself to these poetic acts of creation, acts of love4 where I imagine myself intensely, merging with the great sea of life beyond the me and becoming one:
  • 161. mystic, seer, poet. 1 1952-2002 2 Keats, Letters, 27 October 1818 3 Looking back it would appear that at least 3 reconstructions of personality were required: 1968, 1979/80 and 1999; inevitably there were some continuities, one of which was poetry in 1999. 4 The World of Poetry, p. 92. Ron Price 22 January 2002 2. THE FIRE GOING OUT Bahá'ís believe they are taking part in the career of the growth of a world civilization. As Toynbee points out and as human experience thusfar suggests, the exercise is a dangerous one. Toynbee argues that the danger is constant and acute ―because it lies in the very nature of the course which a growing civilization is constrained to take.‖1 -Ron Price with thanks to 1Arnold Toynbee, A Study of History, Vol.4, Oxford UP, 1962(1939), p.122. Toynbee goes on to say that certain ―creative personalities who set a civilization in motion and carry it forward‖ feel the need to carry their fellows with them or ―to make a movement out of something which is a halt.‖2 This tour de force requires strenuous communion and intimate intercourse to impart the divine fire from one soul to another. There is an inward spiritual grace through which the unillumined soul is fired. But the firing takes place through the principle of mimesis and the process is essentially precarious unless it is crystallized in the form of habit or custom.-Ron Price with thanks to Henri Bergson, The Two Sources of Morality and Religion, Alcan, 1932, p.251. You said it Arnold, as you so often do buried in volumes of your endless pages of you‘re A Study of History. It‘s a dangerous exercise for the individual too, Arnold, one continually revealed by abnormal changes and chances, accidents of life like shipwrecks and fires I have observed for half a century in the lives of others and my own dear self: there‘s often demoralization of an inner man and heroism--difficult to admit and even define phenomena in our age-- often subtle, with initiative lost, a kind of burn-out, a kind of salt losing its savour, a flagging of the Promethean elan, the fire going out. Ron Price June 6th 2006
  • 162. 3. SETTLING DOWN Ginsberg‘s autobiographical poetry, his Collected Works: 1947-1980, gives a shape to his life. There is a sense here of theatre, of playing to the crowd, of the location of the self in place and time. There are many anatomies of loneliness. There are our embarrassments at his self-revelations. From drugs to Buddhist meditation, Ginsberg gives us themes which are now somewhat passe; surface superficialities with little depth; philosophy with hardly any detail, growth or complexity. This bardic-comic-poet gives us formlessness and over-simplification, ugliness and coarseness, the impolite and the imprecise, but he also serves up an incredible energy from a vortex of power. -Ron Price with thanks to Marjorie Perloff, Essays on Modernist and Postmodernist Lyric, Northwestern UP, Evanston, Illinois, 1990, pp. 199-230. Price‘s autobiographical poetry, his Unpublished Works: 1992-2002, give a shape to his life that is not available in his other autobiographical genres. There is a sense of history and of the future, of locating himself and his Faith in the moving flow of history, of time. There are, too, a multitude of anatomies here: anatomies of his poetry, his self, his religion, his times and past times. He rarely embarrasses his readers with awkward self- revelations. His Faith seems just about always at the vortex, at the centre, or the periphery, for he has a passion for conveying its story. There is a sense, too, of new beginnings whose roots are in the past and whose branches are in a utopian world which looks increasingly like a world of realism with a recipe for our survival. -Ron Price, Pioneering Over Four Epochs, 2002. I saw my own mind destroyed, temporarily, by some frazzling chemical dysfunction, burnt-out after jogging through suburban streets at dawn, as suggested by Jimmy Fixx and friends concerned with my health. I‘d asked the House for prayers and, although answers usually came slowly in life, this one popped out of the answer box with haste. Then, I settled down to an ease I‘d never known and only quiet burn-outs: just the slow, quiet, laid-back reduction of high spirits, excited enthusiasm and intensities to memorable and meticulously chosen words, observing the melancholy outlook and the propitious events leading our world community to influence the processes towards the Lesser Peace and helping our concentrated endeavour and the magnificent progress of the projects on Mount Carmel. Ron Price 1st edition : 1 June 2002 12th edition: 21 November 2012
  • 163. APPENDIX 10: BIPOLAR DISORDER AND THE ELDERLY--THOSE OVER 65 1. Peak prevalence for bipolar disorders in the community is 1.5% and it occurs in late adolescence and young adulthood. That was certainly the case with me. It is dramatically lower among community-dwelling elderly people, that is, less than 0.1%. A typical general practice like the one I am going to now in a city of some 100,000 in Tasmania Australia, at the age of 69. might include only a few elderly bipolar patients whose effect on the practice is disproportionate to their numbers. In contrast, reports from geriatric inpatient units describe a treated prevalence of approximately 10% for bipolar disorders. This is in comparison to rates of 0.4% for those aged 45-64 years and 1.4% for those aged 18-44. Perhaps young bipolar patients "burn out" after many years of illness and so are not found in the community among the elderly. By and large, clinical presentation of bipolar disorders in old age is similar to that in younger adults. Symptoms appear to be less intense, although there is a high prevalence of cognitive dysfunction in the elderly. Geriatric BPD is not uncommon; however, its phenomenology, course, and treatment are "grossly understudied." 2. Nearly 25% of veterans being treated with bipolar disorder and 9.2% of patients with bipolar disorder in one population study are over the age of 60. Needless to say, even if these percentages remain constant, the absolute number of elderly patients with BPD will continue to increase as the number of Americans over 65 years of age grows during the next few decades. On the basis of current estimates, the number of Americans over the age of 65 with a psychiatric illness is expected to more than double, from the approximately 7 million currently to a projected total of 15 million by 2030. 3. It is also important to mention that one can further subdivide the geriatric BPD patient population into 2 subsets of patients: those with early-onset BPD who have had the disease since childhood or young adulthood, and those with late-onset bipolar disorder, generally defined as those who developed the disease after 50 years of age. 3.1 In general, age-related changes in the brain and major organ systems affect the pharmacokinetics and pharmacodynamics of psychotropic agents. Elderly patients also tend to have a decreased ability to metabolize medications and an increased sensitivity to adverse medication-related side effects. In addition, the risk for drug-drug interactions is high in an elderly BPD population. This is because most geriatric patients are taking medications in addition to psychopharmacologic agents. There is a need for well- controlled studies in elderly bipolar patients to understand the pathophysiology of the disorder late in the life cycle and to understand the proper psychopharmacologic agents and unique treatment needs of this population. 4. I have talked with my psychiatrist about BPD and the elderly since I am at the age of 67 now in the elderly category. His view is that we need to tailor my medications to my bipolar I disorder and go from there. We are, at present, working out a meds package for me to run with in the years immediately head, as I go through the last years of late adulthood(68-879) and old age, 80+, if I last that long. CONCLUDING WORDS
  • 164. With the most recent visits to my current psychiatrist in 2012, I bring to an end my account of the last 50 years of the major manifestations of this BPD in my life: 19 to 69. As I say above in this lengthy clinical story, the years from conception to 18 which I have commented on briefly had their problems but, in retrospect, the main part of my story did not begin until the last week of September 1963 and October when that Black Dog came into my life and I had no idea what it was. ----------------------------- end of document Back to: Essays and poetry by Ron Price HomeSite MapForumLinksAbout Contact Google search . . script executed in 0.029 seconds

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