Slouching Toward Recovery

The other day a reader, an older bipolar, posed some questions to me:

"How have you managed to find your way through it all? What do you do drug wise that you found to work well?"

I'm not sure that I have fully found my way through it all. I am on a good plateau at a good time in my life. My doctor, a fairly conservative psychiatrist as these things go, uses terms like "recovered" and "remission" to describe me. We've poked at the idea of me going off meds a couple of times. I guess I am in the zone in which a lot of other folks with a mental illness would like to be. But that makes me nervous after many years of struggle. It can all come unglued very quickly. What's more, the science base on what is "recovered" and whether people stay there is remarkably thin.

You'd think docs would want to study and write about people who do well, despite a major psych diagnosis, but they don't. I digress.

My point is I am uncomfortable with all the terminology out there (isn't "recovery" an AA thing?) and, hell, with everything I am about to say. It's one man's experience and one man's observations of hundreds patients and one man's reading of the clinical literature over the years. Seriously, I've talked publicly to NAMI and NMHA groups in Washington State and Montana about recovery. People sat there like I was going to turn them onto the Holy Grail. In reality, I had little to offer other than my own physical example--I was standing there, I had a semi-responsible job and I could speak in complete sentences. I don't even remember what I told them.

I've poked at some of these ideas before on this blog, so what follows is a rough attempt at trying to pull it all together. Really rough. One man's slouching toward recovery.

The biggest thing you've go to do is accept your diagnosis (and this comes from someone who has issues with some of the diagnoses and diagnosticians), or you are going to be wrestling with yourself for a long time. It's not worth doing. You know damn well that something is up with you, so what do you intend to do about it?

Two basic operating principles: No suicide. No giving up. Once you get those operating principles into your life, it gives you the ability get down to the most important matter of all, which is environment. You must have as much control of your total human environment as you can possibly manage. In the workplace. In school. At home. With friends. Out on the town. Anyone with bipolar disorder, depression and schizophrenia who's had it for more than 15 minutes and is somewhat reflective on their state knows that there are certain things and situations that don't work out well for them. Or which flat out screw them up. Like working too many hours. Or multi-tasking far too much on the computer. Or playing games with meds and dosages. Or whiffing a gram of cocaine. And so on.

But, yeah, creating an environment that works for you and creating a pattern of life that helps you is utterly essential. It is from our environments and human interactions, after all, that we draw most of the meaning in our lives, so it's a good idea to make whatever sacrifices you need to in order to square those away. Some of this is known as social rhythm therapy. I call it getting your shit together.

You've got to adopt a no-excuses mindset. This means you've got to stop blaming the illness alone when things get dicey. You've got to dispense with the learned helplessness that the mental health system in this and other countries impose on patients. It's fine to talk about depression as being bad and you need to try all the available treatments and so on, but there comes a point at which that whole approach takes far too much responsibility away from the patient for how they are progressing long-term (I am not talking short-term crisis situations here) and leaves the patient with little control of their own situation. This works out nicely for doctors and pharma companies, of course.

I sometimes think our mental health system in the US is little more than an immense learned helpless experiment ("There's a 30 percent chance you'll kill yourself!" "You won't hold down a job"). And we're the rats. Or the capuchins. But I digress.

You've got to get on as few meds as possible as soon as possible. I am sick and tired of running into bipolars who are on five meds at once--I ran into one the other night and it wasn't clear to me how the poor woman was standing up. The research isn't there to support long-term polypharmacy (to me, that's more than two meds), so why doctors are so willing to lean on it with patients for so long is beyond me (I've got no problem with it in short-term crisis situations). Feel free to point me to any patients who are on five meds and whose life has been sparkling success for years on end.

The truth of it is that every bipolar I've ever met who's done well long-term has been on one med, sometimes two.

But no matter how many meds you are on, you've got to accept that you will always have symptoms. From time to time, they will break through or you will feel them coming. It's a good idea to have a few methods of your own to address symptoms before things go full-on syndromal. I've covered this elsewhere before. If there's a med like Ativan or Seroquel or whatever that you can take for a few days to knock things down, then go for it. The other biggie is that you've got to eat regularly. And for god's sake, keep the processed food and refined sugar to a minimum.

Sleep is huge, too. It is also self-explanatory. As is getting a modicum of exercise. And so on.

My own feeling is that you've got to approach bipolar disorder as a personality disorder--or even as an environmental disorder--as opposed to a strictly biologically-based illness. You get to work on all the behavioral problems and cues and triggers then. I know that's a heretical thought, but so be it. I happen to find it empowering. I'll lay my money on individual humans and their wills any day.

"What do you do drug wise that you found to work well?" was the reader's second question.

What I am doing right now is Lamictal, 200 mgs. per day. It's not perfect, but it's a nice change from three and four meds at a time and the blasted atypicals. Back in the day, Lithium was pretty good for a few years, but then I made the mistake of letting the docs get me on Prozac and the like. And, as recent research shows, anti-depressants aren't especially effective for bipolars. The side-effects made me sick. Gee, it only took researchers 15 years or so to figure this one out!

Depakote was OK, too, for a time.

The bottom line with meds is that you've got to be in control of what you are taking or not taking. Doctors work for us, not the other way around. And, if you are unhappy with a med and want to go off, then you need to go off it under medical supervision--playing games with powerful medications is not smart.

That's all I can push out of my brain for now. Hopefully, it answered some questions. Or raised some other ones. Soon, I will come back to this subject by way of these "quality of life" studies that are now enjoying a certain vogue amongst researchers working with bipolar disorder.

Posted by Philip Dawdy at April 2, 2007 12:58 AM
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