Self-Medication and Bipolar Illness


ball  Welcome to the roller-coaster...

ball  Name your poison (naming as an act of recognition)

ball  Bipolars: Romantic Renegades???

ball  Is there help?

ball   Personal Tales and Terrors

ball  So what do we do then?

ball The Roller-coaster: Or Why We Self-Medicate.

Yesterday you were flying high with ripples of feel-good euphoria that painted your world in iridescence. Today there is no color; all is black and shades of gray. What tomorrow will bring in terms of your moods, no one knows, least of all you. That is the fundamental blessing and curse of this illness. To be bipolar is to feel supremely witty, brilliant, sexy, aggressive and powerful one day, only to fall crashing to the depths of black despair where even getting out of bed is more than you can handle. It's to find yourself at suicide's door...and sometimes (sadly) it means turning the knob to pass through to death's embrace and eternal nothingness.

The rate of suicide for bipolars is somewhere between 15-20%, which is extremely high. I believe that one of the reasons it's that high is that we bipolar folks get to see and be somewhere most people will never go. During the highs (mania), great projects are completed, great artistic endeavors become real, and charm is our password to any realm. Unless...unless the manic muse of happiness becomes the Gorgon of manic rage or manic psychosis.

Why is it called rage and not anger? Imagine somebody igniting a barrel of magnesium versus a spitting little sparkler and you'll have a visual analogy. The best example of manic rage I can offer is my own experience. It starts with a hot rush in the center of my being, working it's way from the pit of the stomach like lava rising to the lip of overflow on a volcano. At some point my brain switches from rational mode to psychotic maniac. Under the influence of the gorgon, I've destroyed petrol/gas station restrooms, attacked a friend, strangling her till several football players pulled me off her. She bears the throat scars still 25 years later. I tried to jump from a car traveling 70 mph and severely bit the person who tried to stop me . Her injuries required medical attention. I've swung at someone by punching through a glass window several times, thus ending up in the hospital for extensive surgery to reconstruct a destroyed arm. This injury required months of physical therapy and left me with only partial use of the hand due to the severe nerve and tendon damage. And that, my friend, is manic rage.

Manic psychosis is the most extreme form of mania and almost always requires hospitalisation. A person this whacked out needs some quick, professional help for they are generally completely out of touch with reality. Left to their own devices they often end up on the streets unable to take care of themselves and are easy prey for unsavory types. It's crucial that a well-informed physician diagnose a person in this condition for it is often the case that bipolars experiencing severe mania are misdiagnosed as schizophrenic. Some of the symptoms of this form of mania are auditory and visual hallucinations along with paranoia.

ball Poison: My Favourites

Among the bipolar ranks are a quite significant number of serious substance abusers of a certain ilk. We tend to prefer both those drugs which will mellow out the highs and juice up the lows, and vice versa. My own choices were cocaine and alcohol of which I consumed prodigious quantities. Others prefer downers (tranquilizers etc) ordrunk_gif marijuana and speed. I was a multiuser myself, depending on what was available. I dealt drugs to enable my habit and hustled pool for drinks. My day often began with a few shots of whisky and a couple of lines of coke to get me rolling. It was anybody's guess where it would end. I still managed to pursue an academic career and other interests during these times, which is a testimony to what can be accomplished during a manic phase. It wasn't unusual for me to write a 20-30 page graduate term paper in a night.

At any rate, it's important that you analyze the substances you are using and why. If you find yourself using drugs to accelerate an already elevated euphoria, or using another drug like alcohol or pot to "take the edge off," try to see if you can determine a pattern in your use. Do you go for periods of time without using anything? Do you binge? Do you drink to calm down? Do you use a drug to pull you from depression or to hide it? Are you an extremist in your use, never moderating it? In any case, if you find yourself drawn to mostly alcohol and an "up" drug such as coke or speed (cocaine and amphetamines), and you have many of the other symptoms of bipolar illness then ask yourself the following: Does my substance use interfere with my life? If the answer is yes, then it's quite possible the two are related and you are a candidate for treatment on both counts. The conjunction of substance abuse and bipolar illness is not accidental by a long shot and there is ample research to support this contention. In any case, the first step toward understanding your illness is to name your chemical conspirators. Conspiring with you (and against you) are the various legal and illegal mood-altering substances, from alcohol, nicotine, cafeine and chocolate to the full spectrum of illegal or illegally-gotten drugs.

ball Renegades: What? Who? Me???

Yes, me...and maybe you too. We tend to be renegades by nature and not by design. Why that is so brings us to a difficult subject with bipolars and psychiatrists alike. It is a somewhat philosophical subject as well since it's impossibly tangled up with what it means to be a "self" and a "person" in our own right. Discussions amongst already diagnosed and in-treatment bipolars can get a bit heated. Some claim no part of their personality is uninfluenced by their illness, while others claim that most of their personality is not dictated, infected, affected or informed by their being bipolar.

tough_guy_image I tend to think that: 1) If BPD is biochemically based, and 2) If we are genetically predisposed to it as is accepted, then 3) Once the predisposition becomes a reality, there's no way any part of our personality can said to be uncontaminated by the disorder. Given that, 4) It's not surprising that such a potent cocktail often produces some rather unusual personality types.

In any case, a significant number of bipolar types can be forces to contend with because of their keen, sharpened senses and wit, and an exaggerated ego equipped with an excess of bravado. If you add substance abuse to this already volatile mixture, I can almost guarantee you'll end up with either a renegade or a corpse--sometimes both, in that order. So, if you find you're often the charismatic leader of the pack, perhaps it's a combination of your genetic birthright and an abundance of legal and illegal chemicals that made you so. Beware the bravado doesn't land you in jail or the hospital--it's done both for me...but I always had my fans cheering me on. And you know what? Sometimes it was awful goddamn fun too! And that's why we bipolar types grieve--because there's a part of us the drugs rob us of. I won't lie to you; I've had a helluva run in my time, and I miss the frenzied peaks--but they nearly killed me. So now I take the drugs that keep me semi-sane and make the best of it. Learning to deal with bipolar grief means learning to say goodbye.

ball Is There Help???

The short answer is: yes and no. Yes - everybody and his brother has a way to cure the drunk, fix the junkie, stop the coke head or crack head, and keep the uppers and downers away from the user, but guess what folks? Most of them have statistically miserable recovery rates and don't let them lie to you about that! Substance abusers can play the "make-me-well-game" better than any healthcare provider or family member can begin to imagine. So, no - the help any dually-diagnosed bipolar needs must ultimately come from him/herself. You cannot and will not save a person who doesn't want to be saved. So given that, all you loving caregivers out there need to get this through your heads--if the abuser doesn't want to help themself then there isn't jack shit you can do to fix them. Sorry for the lingo, but you must come to terms with this for your own sanity's sake!

So what does it mean to say the help a bipolar substance abuser needs most must come from him/herself? It can mean one of two things actually: 1. If the abuse is primary to the bipolar disorder (meaning it appears to be a clear case of self-medicating as a way to deal with the symptoms of the illness), then chances are pretty good that with the right cocktail of psychotropic drugs the person will feel less compelled to continue to abuse. 2. If, on the other hand, the drug of choice is secondary i.e., pursued for reasons unrelated to the bipolar disorder, the person may continue a pattern of abuse even with drugs for the illness. Thus, their addictive behavior becomes an interfering factor with both the efficacy of the drug therapy itself and with the ability to remain drug-compliant. It is the latter that perhaps is most often the culprit when the dually-diagnosed hit the skids and fall out of the safety-web of family, friends and physicians.

ball So what do we all do then?

Short answer?? Cry a lot--because you will, and that means both you who love the troubled bipolar and yourself, if you are bipolar. many_?marks_imageLike it or not, we (as bipolar persons) are in this together with those who have at times been both a source of love, and sometimes, a deep well of heartache for us, and we for them. No easy answers here so I will only say a small bit and then I encourage you to read some of the personal tales of other bipolar persons. Also, I urge you to follow the links below for additional information. In the meantime, let's think positively and move on to some alternative methods for dealing with self-medicating behaviors.

You will find an extensive tutorial on this site which will teach you in detail how to think through dealing with this illness. The information is essential for both you (the person who has a bipolar diagnosis) and the caregivers (private and professional) who surround you. For the complete tutorial that will help you to cope with your condition and get out of the quagmire of thinking with your emotions rather than your brain, see Thinking Through Bipolar Illness ©.

The first two modules of the thinking course are now net-ready--thanks for your patience :)



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