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Bipolar Disorder

Ups and Downs

A very short story about a person with bipolar and his wife.

Capra Royale, CC 2.0
Source: Capra Royale, CC 2.0

Some of my recent posts have used a short-short-story format to explore a common mental disorder.

Today's offering is about a 30-year old with bipolar disorder, which afflicts. 5.7 million American adults.

"Get your hands off me!" William screamed. Two orderlies held him down as his wife, Amelia, looked on and the nurse administered a shot of Zyprexa to control his psychosis and of lithium to stabilize his mood.

This was William's third hospitalization so Amelia knew the drill. When his mania reached the point of psychosis it was time to call 911. This time, he had yelled, "I'm famous. I'm stronger than anyone" and proceeded to sweep the entire sideboard of dishes onto the floor.

Other times, William insisted he was just a step from inventing some amazing drug or device, sometimes three "breakthroughs" within one hour, none which ever came to fruition. Or he'd deem himself a sexual superman and demand constant sex from his wife. On the other hand, he might drop from normalcy into deep despair, with no desire for sex, no desire for anything---All was useless, all was black. He became addicted to heroin as a way of escaping his pain. And he has attempted suicide twice. (According to the National Institute of Mental Health, "at least 25 to 50 percent (of people with bipolar) attempt suicide at least once.")

William's co-workers would have been surprised at all of this. Sure, he took an unusual number of days off. And sure, he was super high-energy during crunch time and collapsed afterwards but his colleagues just viewed that as his having given his all for the project. And he was able to be functional most of the time because he faithfully took his medications even though they made him feel off, even sometimes "like a zombie."

The Zyprexa shot worked and his psychotic symptoms quickly dissipated. And he is one of the 1/3 for whom lithium, the first-choice mood stabilizer, works. (A study just reported in The Lancet found genes that may determine for whom lithium will work.)

So after an eight-hour observation, William was allowed to go home under Amelia's care. Before they left, the doctor suggested that William consider electro-convulsive therapy, which often is helpful in cases where maintenance doses of mood elevators, anti-psychotics, and cognitive-behavioral therapy are insufficient.

Alas, almost as soon as they got home, Amelia noticed the telltale smell of marijuana. "William, damn it, you know that pot probably helped cause your bipolar and it certainly exacerbates it--and you're smoking again?! Do you want to go back to the hospital?! He kept smoking as he said, "It's mainly genetic. My father was manic-depressive and I've read the research. They've even identified seven candidate genes." Amelia responded, "They're only candidate genes. It's not certain yet. Besides, if you have the genetic predisposition, you're more vulnerable to the effects of pot."

Finally, exhausted, William fell asleep, whereupon Amelia, 32. plodded to the kitchen table, sat down with a cup of tea, and sighed in relief. And she started thinking: "I can't take a lifetime of this. But I promised 'in sickness and in health,' and I knew he was bipolar back then and I still chose to marry him. I guess I rationalized that his highs were so exciting, and he was smart and successful. I never thought it would get this bad...If I tell him I'm divorcing him, could he try to kill me? Should I lie and tell him I need to visit grandma for a week or two? Should I call a lawyer? Get a restraining order? Get him committed? Or maybe my lot in life is to stay with him. There always are new treatments under investigation He just got invited to participate in a clinical trial of a new drug regimen that in the first trial, brought into remission 4 of the 7 patients who hadn't responded to traditional treatment. I just don't know what to do."

The National Institute for Mental Health has a website with much information on bipolar disorder, including sources of support. .

The 2nd edition of The Best of Marty Nemko is available. You can reach career and personal coach Marty Nemko at mnemko@comcast.net.

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