One Day at a Time. A Journey of One and Many Bipolar Disease and its Many Challenges.

Bipolar disorder, also know as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, and activity levels, and the inability to carry out, day-to-day tasks. Bipolar disorder is not easy to spot when it starts. The symptoms may seem like separate problems, not recognized as part of a larger problem. Some people suffer for years before they are properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a persons life. Symptoms of bipolar disorder are severe. They are different from the normal ups and downs that everyone goes through from time to time. Bipolar disorders symptoms can result in damaged relationships, poor job and school performance, and even suicide. But bipolar disorders can be treated and people with this illness can lead full and productive lives. According to the National Institute of Mental Health, almost -5.7 million American adults, or about 2.6 percent of the U. S. population age 18 and older, are diagnosed, on any given year, with Bipolar disorder, also known as manic-depressive illness. This case study will provide an introduction to bipolar disorder. In doing so it will focus on Rocios life experience and how communication has allowed her and her family to better understand and cope with the ups and downs of manic depression. As high as the numbers may be, this illness is often not recognized due to the fact that the symptoms may be related to other medical or personal reasons and proper diagnosis and treatment may be delayed for years. The first minute Rocio: Day X: It is 3 oclock in the morning. I am going insane. A conversation is going on inside my head and I cant make it stop. Back and forth the voices argue. I am tired, but cant sleep. I scream. I cry. The voices wont stop. Day 2: I have been cleaning house all day long. The stereo is on, and so are the TV, the washer and the stove. I feel GREAT. It is 1 oclock in the morning and I

am not tired. Before long the house will be sparkling clean and I will be ready for the new day. Day Z: Cant get up from bed. It is the middle of June but everything is gloomy. There is an overwhelming sense of Guilt. Nothing seems OK. Everything hurts so badly. I need to make the pain go away. I need to numb the pain. Cant deal with the PAIN Jerry: I was not prepared for what life was about to throw at me. I had been working in a military hospital and had observed many depressed patients, but the last thing in my mind, when I was asked to go see my wifes neurologist, was that Rocio had been thinking about committing suicide. At that moment I was angry, I felt rejected. How could she trust an outsider with such concerns? I should have been the one to know first. I had no idea of what was going on. I just heard the word psychiatric Ward. Immediately I recalled images of tied down, drugged, crazy people. No that was no place for Rocio. Doctor: We must supervise her on a 24/7. If the husband feels that he cannot provide for constant monitoring than the patient should be admitted to the psychiatric Ward. Six months later: Jerry: I was not allowed time to comprehend what was going on. My wife had attempted suicide. Why? I had no idea, but there she was in the emergency room. Just hours ago we were celebrating the birth of our second son. Now there I was. Yes, I knew my wife had been diagnosed with mayor depression, but she had been doing Ok, at least I thought so. How could this happen to me? I was not prepared to make any decisions. What did I know about mental disorders, depression, or bipolar disease? Doctors new best. At least that is what I wanted to believe. Doctor: Your wife attempted suicide. It is not safe for her to go home your wife is experiencing a mayor-depression episode. We need to conduct a series of workups to rule out any medical conditions. For her safety it will be wise to admit her to the psychiatric ward. There she will be safe. Rocio: I really dont know what time it is. I feel tired, scare, and lonely. Someone is watching me. I want to leave. I dont want to be here. Do they care, NO! They have decided that the outside World is not a safe place for me. They decided and I

must obey. I dont know what all this means. Nothing is making sense. All I want to do is go home. This is how Jerry and Rocco experienced the beginning of the following 17 years of their lives. Just like patients with cancer those faced with a mental illness such has Bipolar disorder must also face several emotional stages before accepting the condition. Rocio and her family went through the shock of being forced into an unknown world, which asked many questions but gave few or no answers. This was shortly lived. The family had to move forward, for patients sake. Bipolar disorder is a complex brain illness, which expresses itself as irregular changes in mood, energy, and thinking. Because these changes can be subtle, and differ from person to person they are a challenge for individuals, families, and care providers. Suicide is an ever-present danger on both sides of mood swings: a subgroup of people can become severely suicidal in manic or mixed (high and low together) states. Use of drugs and alcohol can be fatal, as these substances lower whatever protective inhibitions may still be present. Everything looks fine, so everything must be fine. Ignoring the signs. Rocio: The kids are out to school. The house is sparkling. The walls are freshly painted, and the roses are in bloom. All before noon. GREAT! Lets go shopping. Jerry: Life cant be better. Everything is in shape, the kids, the house. Rocio, she could not seem any happier. She must not be depressed anymore. The medicines must be working. Psychologist: There is little conversation taking place. Patient reports that she is feeling well and is actually not taking her medications due to adverse side effects. Will monitor mood levels. Patient has appointment in one week. Doctor: Patient has discontinued treatment, reports feeling well. Will see her in a month. A breakage in the communication lines can be a mayor obstacle in any situation, but when it comes down to Bipolar disorder, it can make the difference between life and death. Because there tends to be little understanding or even denial about the disorder, many patients, their families and caretakers move in different directions. Some of this is caused by uncertainty. If the situation is ignored long enough maybe it will go away

The fact that other medical conditions may overlap with bipolar disorder also impedes communication because patients and family members may be more understanding or accepting of a diagnosis of lupus or hypothyroidism than face the stigma linked to mental illness. To tell or not to tell Rocio: I feel guilty as it is with out having to face everyones questions. Why did you do it? What were you thinking about? Are you ok? Everyone is now an expert. They tell me what I should and should not do. I cannot get upset because they worry. Why do they have to know? Jerry: I have always been close to my family. They have always been there for me. I needed support and my parents were there for me. The only problem is that they told my sister who told my brother who told his daughter. You get the picture. Now everyone in the family knows. Stigma related to mental illness, is well known to exist. Families worry, do not know what to do, and most importantly they may feel ashamed when confronted with the reality of facing mental illness. For centuries patients faced with retardation, schizophrenia, anxiety, and even melancholy as depression used to be called were separated from society and placed in asylums. Many people think of mentally ill patients as dangerous, mentally challenged, or bothersome. It is this thinking, which still creates stereotypes, and biases, which keep many people from accepting, facing, dealing, and even talking about mental health conditions. All for one and one for all, what teamwork is all about? Rocio: Several years, 15 in total, have passed by since I was first hospitalized with what doctors called mayor depression. Six years later it was finally concluded that what I was actually dealing with was the highs and lows of bipolar disorder. The ordeal has left many a hurt feeling and unanswered questions. I have not completely learned to live with what people call normal mental states. Like a doctor once told me: just because you can drive 120 miles an hour does not mean that you should. Well, now I know what it is that ails me, and this knowledge has given me back the control I had lost. Still I miss the rush of being able to go at 120 miles an hour.

Jerry: Life is still not easy. I must stay alert to Rocios shifts in mood. She has learned to recognize when she is going into extreme mood changes, but she still misses the more subtle ones. I think she actually likes it when she is in high gear. Doctor: The patient is active and in compliance with treatment. Medication levels are with in normal, and side effects are minimal. Will follow up in 2 weeks. Both the patient and her husband are in agreement. Today Rocio and her family have learned to take control of manic depression. By acquiring up to date information in books and the Internet, they have learned to detect the warning signs of the disorder, (see Warnings Signs table). For example, they have learned to monitor Rocios speech patterns. If her discourse becomes disconnected, or deviated they start paying attention for other warning signs like sleeping patterns. In this simple way they can monitor the disorder with out having to rely on the to often-misused question, how do you feel? They have accomplished what many call a normal life. They have learned to compromise. They must follow and monitor daily routines. But most importantly the family has developed a better communication system. They have also established emergency protocols, which include room for individual and group emotional support. There is also an increased awareness of how diet, exercise, and stress interact with each other. Every family member is an active caretaker when it comes to Rocio well-being. Rocio: The ordeal is not over but now we are armed with information and means of discerning it to those who may need it. We are better prepared to deal with questions and when relapses happen they are treated as such. Bipolar Disorder is part of our lives, but it no longer controls our Jerry: I still worry about Rocios bipolar disorder, but I am no longer completely absorbed by it. Doctor: Both Rocio and Jerry have leaned to monitor the sighs of mania or depression. They know where and how to reach me if necessary. Prognosis is favorable. Will see patient in one month. Leaning to live with bipolar depression, manic depression or bipolar disorder is not an easy task. It requires that family members and close friends to be supportive and

willing to listen. Caregivers also need support and the opportunity to talk to others who may understand and who can help. Understanding comes with knowledge and with it acceptance and respect for whatever level of wellness the loved one may attain. By understanding that Bipolar disorder is like any other chronic disease, Rocios family can now better deal with mood shifts, communication challenges, outsiders questions, and the still ever present stigma.

*Additional Material Warning signs A person may be having an episode of bipolar disorder if he or she has a number of manic or depressive symptoms for most of the day, nearly every day, for at least one or two weeks. Sometimes symptoms are so severe that the person cannot function normally at work, school, or home. Symptoms of bipolar disorder are described below. Symptoms of mania or a manic episode include: Mood Changes A long period of feeling "high," or an overly happy or outgoing mood Extremely irritable mood, agitation, feeling "jumpy" or "wired." Behavioral Changes Talking very fast, jumping from one idea to another, having racing thoughts Being easily distracted Increasing goal-directed activities, such as taking on new projects Being restless Sleeping little Having an unrealistic belief in one's abilities Behaving impulsively and taking part in a lot of pleasurable, high-risk behaviors, such as spending sprees, impulsive sex, and impulsive business investments. Symptoms of depression or a depressive episode include: Mood Changes A long period of feeling worried or empty Loss of interest in activities once enjoyed, including sex. Behavioral Changes Feeling tired or "slowed down" Having problems concentrating, remembering, and making decisions Being restless or irritable Changing eating, sleeping, or other habits Thinking of death or suicide, or attempting suicide.