Diagnosing Bipolar II #DavidLeite #NotesOnABanana

Creator of the James Beard Award-Winning Website "Leite's Culinaria," David Leite, "Notes on a Banana: A Memoir of Food, Love, and Manic Depression"

“Diagnosis: Mental Lite!” — Chapter 33 of David Leite’s self-deprecating Notes on a Banana: A Memoir of Food, Love, and Manic Depression — reminded me of the two decades it took before I was diagnosed bipolar type 2.

For twenty-five years Leite was treated (unsuccessfully) for depression and anxiety. Like Leite, I was an overachiever who cyclically crashed. From eighteen to thirty-nine, I was diagnosed dysthymic (chronically depressed).  Finally as a mother of a toddler, I recognized my euphoric callings from God as symptoms of hypomania and called for help.

After seeing numerous psychiatrists since he was fourteen, Leite sought and got an accurate diagnosis of bipolar II from Neil De Senna, who at the time was a Columbia University Medical Center professor of psychiatry.

Here I excerpt as bullet points the questions Dr. De Senna asked that led to Leite’s diagnosis. Buy the book to read his life story and answers to these questions — you won’t regret it.

  • Did I ever have rapid, repetitive thinking?
  • Did I ever talk fast, sometimes so fast people couldn’t understand me?
  • Had I ever been so irritable, I shouted at people or started fights or became violent?
  • Had I ever had a decreased need for sleep? If I slept just a few hours, did I feel great?
  • Did I ever engage in risky behavior that endangered my life?
  • Had I felt unusually self-confident in myself and my abilities? Did I ever experience grandiosity?
  • Had I ever had morose, violent thoughts?
  • Had I ever contemplated suicide? Had I ever attempted it?
  • Had I ever lost interest in things because nothing gave me pleasure?
  • Were there times when I was very interested in being with people, and other times when I wanted to be alone?
  • Did I have crying jags, anxiety and panic, trouble falling asleep or staying asleep, bad feelings about myself?

Now I quote without editing, De Senna’s description of bipolar I and bipolar II:

He explained that there are two types of bipolar disorder. Bipolar I is the more severe form, what Kay Redfield Jamison, the author of An Unquiet Mind, has. In it, the manias are screechingly amped up and oftentimes dangerous. They’re emblazoned with inflated self-esteem and billowing grandiosity, a marked decrease in sleep, a pressing need to talk, sometimes with odd features such as “clanging,” where speech loses meaning and follows a pattern of rhymes or sounds. Someone suffering from full-blown mania can be grossly distracted; battle racing, looping thoughts; and engage in potentially dangerous and deadly activities, such as unchecked buying sprees, risky or anonymous sex, foolish business dealings, and reckless driving. All the while, psychosis—a disconnection from reality—can be skulking in the background, just waiting for a pause, an opening. These manias can disrupt a person’s life to such a degree that jobs are lost, relationships implode, families disintegrate. Hospitalizations usually follow.

“What you have, bipolar II,” he continued, “is a milder form of the illness.” While the depressions can be just as deep and disabling, disabling, he said, what makes the difference is the quality, degree, and length of the high times. With bipolar II, a person suffers from hypomania. Elevated, expansive moods that are seductively attractive to the sufferer and the people around him, hypomanias are a watercolor version of bright-neon manias. Through it all, life isn’t disrupted to the same degree, and there’s never a psychotic break. Hospitalizations aren’t common.

“It can be very, very difficult to diagnosis hypomania,” Neil said. “Especially in type-A people who are normally goal-oriented, high energy, and creative. Their personalities can mask the illness at times.”

By quoting from David Leite’s memoir, published by HarperCollins, I do not intend to avoid copyright law. My hope is to educate, and as an added bonus to Leite and HarperCollins, to promote a great memoir of a creative soul living with manic depression.

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Verbal Non-Verbal

verbal

Sometimes, I’m verbal
The words rush
They press
They insist on getting out of my head
They keep me awake at night
Unless I shut them up
Turn them off with meds

Sometimes, though,
I’m simply not
Sometimes, I’m non-verbal
The words are not there
I do jigsaw puzzles
Watch TV
Play with numbers
Rather than words

When the words fly
They are raucous
Noisily filling my mind
Needing to get out
I need relief
So, I write

Then, I must get
The racing commentary
Out of my mind
Onto the screen or paper
In black and white
Where later I reshape them
Edit them into something coherent

Perhaps
Or, perhaps,
Sometimes, I leave them
In a jumbled mess
All over the page

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In My Own Voice

The weekend after I attended BlogHer16, my local NAMI Orange County office hosted an In Our Own Voice (IOOV) training.

In Our Own Voice (IOOV)

Hi, I’m Kitt O’Malley

  • Mother of a teen son, wife, mental health advocate
  • You can find me any given day on social media
  • I enjoy reading, writing, art, photography, flowers & nature
  • Relate to audience

The National Alliance on Mental Illness, or NAMI, is the nation’s largest grassroots organization dedicated to improving the lives of persons living with serious mental illness and their families. Founded in 1979, NAMI has become the nation’s voice on mental illness. With organizations and affiliates in every state, NAMI effectively provides advocacy, research, support, and education about serious mental illness. Members of NAMI include those living with mental illness, families and friends of people living with mental illnesses, mental health providers, students, educators, law enforcement, public officials, politicians, members of faith communities and concerned citizens.

Services NAMI provides include mental health education and support programs. NAMI Orange County offers numerous programs and support groups.

When NAMI volunteers do official IOOV presentations, we show a 15-minute video divided into five different segments: Dark Days, Acceptance, Treatment, Coping Skills, and Strategies & Successes, Hopes & Dreams. After each segment, we pause the video, tell our own brief personal story, and then leave time for discussion and questions. Here I share my story. Haven’t yet done this in person, just been trained, but I look forward to it.

Dark Days

When I was an 18-year-old freshman UCLA student, I fell into a deep suicidal depression. It truly was a living hell. I believed that my family, the world in fact, would be better off without me. But, though that time was dark, and I’d never wish the pain of deep depression on anyone, those were not my darkest days.

At my friends’ insistence I sought help. I lived with chronic depression with the help of therapy and later medication until I was a 39-year-old mother of a very active toddler. At that time, I experienced a feeling of elation believing that God was calling me to attend bible study at one church and spiritual direction at another.

As a former psychotherapist and as someone who had to be carefully dosed with antidepressants, I recognized the feeling of elation as hypomania. The change of my diagnosis from depression to bipolar disorder type II changed my perception of myself.

I believed I could be a good mother with depression, but as soon as I realized I had bipolar disorder, I put my son in daycare and returned to work. I thought my son would be better cared for by someone else.

I was the same person before I got that diagnosis, but my internalized stigma, my own negative thoughts about what having bipolar meant, that I now had a serious progressive mental illness, my belief that my son was no longer safe when in my own care – that was my darkest days.

Eventually my illness made it too difficult to work and parent. I ended up hospitalized. Since then I’ve been home with my son, who actually needed me at home with him. As it turns out, I’ve been a great mom to my son.

Acceptance

Acceptance has been an ongoing process for me. Not just overcoming denial or stigma – but owning my diagnosis and allowing others in to help me. I had been a high achiever, a perfectionist. Accepting that I have a mental illness has involved accepting myself as broken.

To that extent, acceptance has allowed me to forgive myself for not living up to early life expectations. I quit UCLA after my freshman year. Took a semester off. Attended community college part-time before transferring to UC Berkeley. I never became a doctor or a lawyer. But I did get my bachelors, a masters in psychology, and much later even attended seminary (but didn’t finish).

My journey to acceptance has been essentially a spiritual one. I am not weak. I am vulnerable. I am not perfect and flawless. I am loved, lovable, and loving. My life has meaning. My life experience gives me purpose in helping others. And, I am grateful that I am here today speaking to you.

Treatment

My treatment has changed over time. When 18-years-old I sought help at UCLA’s student health services. The cognitive therapy I got helped me to identify my suicidal thoughts, stop them, and rewrite them to more rational thoughts. That skill stays with me to this day. Later in my mid-20s, I studied and sought therapy that explored the effects alcoholism and family dynamics had on me.

Then at 30, as a psychotherapist of severely emotionally disturbed teens, following the deaths of my grandmother and a friend from high school, I fell into a depression so deep, psychotherapy alone was not enough. As I couldn’t even get myself out of bed, with my parent’s help, I went to see first my internist and then a psychiatrist for medication. My reaction to rapid changes in antidepressant medications led to a week of sleeplessness and psychotic thought process.

Once a stable antidepressant regime was found, I remained stable on antidepressant medication and psychotherapy until I was 39. With no changes in medication, like the rapid changes in antidepressant medications that led to manic symptoms when I was 30, I recognized symptoms of elation which I knew from experience and education was hypomania. I called the advice nurse on my insurance card who advised I see a psychiatrist or go to the ER ASAP. I could not get into see a psychiatrist until the following week, so my internist prescribed an anti-seizure medication for me to take until then.

Since that time, I’ve taken a variety of medications as my needs and my body chemistry have changed. I rely on medication, supportive psychotherapy, and group therapy to maintain my mental health.

Coping Skills

Honestly, it’s taken decades for me to develop excellent coping skills. I’ve always been good at asking for help and getting support from friends and family. My social skills have helped me to surround myself with loving and supportive friends and family. I’m honest and open about my symptoms and what support I need at the time. That may mean that I have my husband get take out or make dinner when I’m wiped out and not up to the task.

I make sure I get a good night’s sleep every night. I’m aware of stressors that may make my mood to go up or down. I read and write. Every night before I go to bed, I read to calm my mind and often pray or meditate. During the day I write, blog and use social media to connect with others in the mental health community.

Humor is a fabulous coping skill both for me personally and for my husband and me in our marriage. Finally, I’ve attended NAMI Peer-to-Peer program which introduced me to the concept of mental health recovery.

Successes, Hopes & Dreams

My success has been when I fall, when my journey is interrupted, I reassess and adapt. When I quit UCLA, I took a semester off and then went to community college before transferring to Berkeley. I had hoped to become a doctor, a neurosurgeon, actually. That hope, that dream, that goal changed. I learned that I must take life as it comes, adjusting my goals as needed.

When I fell into a deep depression and later a week of mania, I couldn’t return to work right away. I decided not to return to my profession as a Marriage, Family and Child Counselor, took time off, then worked in a temporary job which led to a decade long career in commercial real estate.

Now, my success is to be a good mother, loving wife, and mental health advocate. I’ve always hoped to be a public speaker. I’m living my dream by telling my story to you. I had hoped to be an In Our Own Voice speaker, and now I am. My hopes and dreams for the future are continued public education about mental illness, overcoming stigma and discrimination, and better research and treatment for brain disorders.

Flight Back Home

Friday, July 15th

Last Saturday, the day after we returned from Oregon, my mother was psychiatrically hospitalized for the third time since her stroke last November. Yesterday morning, I met with the treatment team at her psychiatric hospital. They do not think she needs long-term psychiatric placement. They believe her memory care community is the best placement for her and that she’ll just likely need regular “tune-ups,” returning to the psychiatric hospital when she refuses to take medication and her mental health deteriorates.

Luckily my parents’ house sold, with escrow closing yesterday. This morning I met with a financial planner to invest the proceeds from the sale on behalf of my parents and schedule regular withdrawals to pay for their care. Long-term memory memory care is expensive.

OR Trip
Oregon was beautiful and offered a relaxing break.

Flight Back from PDX to SNA – July 8, 2016

Before returning our rental car at PDX, we stopped for gas. While making a pit-stop, I received a call from my mother’s memory care community which I let go to voicemail. Inopportune time to take the call, as my purse hung on the restroom door handle out of my reach, and I didn’t want to dribble, squat and waddle over to answer my phone. Instead, I’m sharing the impolite (and perhaps amusing) imagery that came to my mind as the phone rang (to temper the vulgarity of the scene, my ring tone is Take Five by Dave Brubeck – yes, I love jazz).

The voicemail confirmed that once again my mother refused to take her medication and threatened violence against the nursing staff at her memory care facility. Once again, time for psychiatric hospitalization. This is getting old. Really old.

I fear my mom may need long-term psychiatric placement. Locked psychiatric care 24/7. Do not know what is available. Time to reach out for help. Time to research geriatric psychiatric residential placement for mom. Fuck.

That’s all I have to say on the matter. I do feel myself coming to tears. I fear, too, ending up like mom. Crap.

Shit.


Now I’m just spent. I did have a good time this week in Oregon. It was a nice break from my life, from my responsibilities, from the mess and clutter that is our house, from the mess and clutter that is my life.

We went to the wedding of one of our many nieces last night. They wed under Cathedral Bridge (St. John’s Bridge). The bridge is built with stunning Gothic arches and a backdrop of trees along the river. Then we had an incredible dinner at Plaza Del Toro. Very upscale and gourmet. So delicious. Loved it. Wish we had that kind of food in our neighborhood.

I look forward to getting away again and again and again. I need these breaks, these respites.