Consistently Inconsistent


By: Jakob Lee Fuller
(A current sufferer of Bipolar Disorder type 1, ADHD, PTSD (Post Traumatic Stress Disorder), Severe Anxiety, & Insomnia)

Consistent – Constantly adhering to the same principles, course, form, etc.
Inconsistent - Lacking agreement, as one thing with another or two or more things in relation to each other; at variance.
[9]



Table Of Contents
1.) (Prologue) What Is Bipolar Disorder?
1.5) My Experience (What Bipolar Is To Me)
2.) Symptoms & Diagnosis
3.) The History of Bipolar Disorder
3.5) My Symptoms & How I Was Diagnosed
4.) Causes
5.) Medications & Therapies
5.5) My Medications & Treatments
6.) Coping Skills, DBT, & Mindfulness
7.) Studies & Research
8.) Statistics
9.) Mental Illness Stigmas
10.) Advice
11.) Bibliography & Index




What Is Bipolar Disorder?
(Prologue)
Bipolar Disorder is a mood disorder. It is defined by the dictionary as “An affective disorder characterized by periods of mania alternating with periods of depression, usually interspersed with relatively long intervals of normal mood.” [9 ] It’s basically an inability to control emotions. Meaning, you could be depressed (“A condition of general emotional dejection and withdrawal; sadness greater and more prolonged than that warranted by any objective reason.”) [9 ] So, you could be depressed for a while, even months at a time. Then switch to manic. Manic is defined as “Excessive excitement or enthusiasm; craze.” [9 ] Most people have no idea they are bipolar. I didn’t know for years.

Why I’m Writing This Essay
After I was diagnosed I did a ton of research and found out exactly what bipolar is. I also found out that it matched me perfectly. In this essay I’m going to share with you everything I’ve learned and gone through with bipolar. I hope this can be a valuable resource for other sufferers of mental illness. Not only with bipolar but, with all sufferers of mental illness and disorders.

What Bipolar Is To Me
Bipolar to me is a big change. Once you’re diagnosed it seems like your whole life changes around it. Last week you were just a kid struggling with your emotions. Now you’re on medications, a daily schedule, and regular therapy sessions. It changed my life.

Symptoms & Diagnosis
Psychologists use a book called the DSM (The Diagnostic And Statistical Manual Of Mental Disorders) [8] The newest, most up to date one is the fifth edition. Using this book, psychologists can diagnose patients based on a certain, strict criteria of symptoms. The following is an excerpt from the DSM-5 to show how psychologists specify and diagnose types of bipolar disorder. The numbers on the left are codes to specify the various additions to the disorder.
 

[8 ] There is vast possibilities of variations in bipolar. It is important to diagnose as specifically as possible to make sure the patient gets the best possible treatment.









The History of Bipolar Disorder
Bipolar disorder can be traced all the way back to ancient Greece where Aretaeus of Cappadocia began detailing the symptoms. His links between mania and depression went largely unnoticed for centuries.
In the 17^th century, Robert Burton wrote the book, The Anatomy of Melancholy, which addressed the issue of treating melancholy (non-specific depression) using music and dance as a form of treatment.
Later that century, Theophilus Bonet published a book titled “Sepuchretum” it drew from his experience performing 3,000 autopsies. In it, he linked mania and melancholy in a condition called “manico-melancolicus.” Centuries later, little new information was discovered about bipolar until 1851 when Jean-Pierre Falret published an article he called “la folie circulaire.” Translated that means circular insanity. The article details patients going through severe bouts of depression followed by manic excitement. This is considered the first documented diagnosis of bipolar disorder. Jean-Pierre Falret documented a possibility of a genetic connection in bipolar disorder, something medical professionals still believe to this day. However, the history of bipolar disorder changed with Emil Kraepelin, a German psychiatrist who recognized biological causes of mental illnesses. He is believed to be the first person to seriously study mental illnesses. Emil Kraepelin wrote “Manic Depressive Insanity and Paranoia” in 1921. The book detailed the difference between manic-depressive and schizophrenia. His classification of mental disorders remains the basis used by professionals today. [11]

My Symptoms & How I was diagnosed
I was about ten years old when my family and I realized something wasn’t quite right. For weeks I would be extremely happy. Too happy. I had these grandiose ideas and inflated sense of self. It sounds normal for a ten year old to be creative and “wild” thinking. I was just a creative and imaginative kid everyone thought. It seemed normal. I wasn’t at all mature, that’s just how kids are right?
I had problems in school. I never seemed to fit in anywhere. I just couldn’t sit still in class or focus on anything. I wasn’t slow or learning disabled. I was always way ahead of the game, especially in reading and writing. It was too easy, I was bored. I remember being sent to the principal’s office a lot in my school years but, one time sticks out to me the most. I just got into middle school. I was sent for disrupting class. I was unable to concentrate which frequently irritated me which then caused me to lash out in a joking manner, playing jokes and making fun or in a violent and angry manner, fighting, yelling, punching walls, etc.
As I was in the office, the guidance counselor asked to speak with me. We went in her office and she asked if I had ever been to a psychologist. I said no. She then called my parents and recommended I go be evaluated by one. My parents did just that. I swear we sat in that waiting room for hours. Finally we got back to the office, it was dark but calming. The psychologist was a girl, she asked me a bunch of weird questions but, I answered them all truthfully because I had a thought that maybe this would help me somehow. When we were finished she brought my parents back in the room and said I’m diagnosing Jakob with ADHD (Attention Deficit Hyperactivity Disorder) , Insomnia (“The inability to obtain sufficient sleep, especially when chronic; difficulty in falling asleep; sleeplessness.”) [9] and Major Depressive Disorder (“A mood disorder causing a persistent feeling of sadness and loss of interests, also called clinical depression”). [9]

So, that was it, I was a mental patient.  I was crazy.  For years I thought I was just another nut case, a lost cause, I should be locked up. When I hit sixteen years old I had developed a pretty heavy addiction to prescription medications. I was known as “the pill popper”. Xanax, OxyContin, Percocet, Vicodin, Klonopin. I did it all and very often. I overdosed four times on separate occasions before finally being made to go to rehab. I went four different times. I was forced to go the first three times. It didn’t work. I wasn’t ready. The day I got out I would go get my pills and forget about the world. I remember though, like it was yesterday. I woke up one morning and something came over me. I don’t know what but, it was overwhelming. I guess I just finally had enough. I got up, got a cup of coffee, smoked a cigarette, packed my book bag full of clothes, and checked myself into rehab. I was there for almost two months and it was the most structured empowering, and debilitating thing I’ve ever gone through. Withdrawal was terrible but, after that was just getting back to life, how to be a normal, productive person in society. As much as I hated it, it helped me more than anything I’ve ever done but, only because it was my choice to get clean and straighten my life up. After rehab I went on to finish school, have a successful relationship, and an amazing and beautiful son. I still had problems I was never able to figure was why I couldn’t hold a job? Why do I have these days where I feel like the best person in the universe and then the next day want to die? No one ever had an answer for me until recently.
 I go to a therapy session every week. We drink coffee and talk about how our week is going. It’s nice to get the anger and frustration out that way rather than by being violent. In one of my sessions they had me talk to the psychiatrist and she finally gave me definitive answer to what was going on with me. She said “Jakob, you are bipolar type one not major depressive; among a couple other things.
Bipolar seems to be your major problem. You have moments of grandiose and exuberated thinking and other days of extreme depression and despair. You are what we call a “Rapid-Cycler”. You rapidly cycle between moods. You could cycle through depression, anger, happiness, and guilt all within a couple hours. It can be very frustrating because sometimes you may feel things and not know why. She was right. A lot of my anger actually comes from those situations. I have days I wake up and feel extremely depressed for no reason and no matter what I do; I just can’t shake it or come up with a reason why I’m feeling this way. Then the anger comes in because it’s a bad feeling when you feel something for no reason. You feel like you have no control over yourself.  That feeling will aggravate anyone, along with the shame. “Why me? Why can’t I be normal?” thoughts which then bring the depression back. It’s a huge spiral, never stopping. To make a long story a little shorter, I had finally gotten my answers. I can’t seem to keep a job because I’m not living steadily. I’m up and down. When you work in a factory the work is pretty much the same day after day. That doesn’t work with someone who is constantly changing. With my moods, my opinions also change. I may wake up feeling good and be thinking “Alright.  It’s time for work. Let’s do this!” but, by lunch time I’ll be in another mood and be thinking something like “This is a dead end job. Why am I here? I’m better than this. I don’t need this. I’m leaving!”  So, then I leave. I did this for years. I always felt terrible about it after an hour or so but, by then it was already too late. I’m jobless. My symptoms as I previously stated were text book bipolar disorder. Massive and rapid mood swings. Irritability, depression, extreme happiness, and a grandiose sense of self awareness.
I was diagnosed recently by a licensed psychologist.

Causes
This is where it gets tricky and complicated. Because there is no definitive answer on what causes bipolar many studies and a lot of research has been done from every possible aspect. Scientists have found in recent studies that there are a few factors that may be contributing to bipolar disorder. Studies have shown that biological differences could be a key factor in bipolar disorder. Patients with bipolar have shown physical changes in their brains. The significance of these changes are still unclear but may eventually help to pinpoint causes. An imbalance in naturally occurring brain chemicals called neurotransmitters has been shown to play a significant role in bipolar disorder as well as other mood disorders. Genetics may also have a role in bipolar disorder. Bipolar is more common in people who have close relatives also suffering from bipolar disorder. Currently, researchers are trying to pinpoint the genes that are involved in causing bipolar disorder. There are factors that may increase the risk of developing and causing the first episode of bipolar disorder. These risk factors include having a close relative, such as a parent or sibling, with bipolar, periods of high or intense stress, drug and or alcohol abuse, and major life changes, such as the death of a loved one or other traumatic experiences. [12]
Patients with bipolar are often found to be suffering from other co-occurring disorders. Often times it’s an anxiety disorder, such as social anxiety disorder or generalized anxiety disorder. Others have been found to be suffering from post-traumatic stress disorder (PTSD), attention-deficit hyperactivity disorder (ADHD). A huge percentage of patients diagnosed with bipolar disorder also have a history or presently occurring addiction and or substance abuse. Drugs and alcohol can actually trigger, prolong or worsen depression or mania. Another commonly found co-occurring issue is physical health problems. People diagnosed with bipolar disorder are more likely to have certain health problems than others, such as heart disease, thyroid problems or obesity.[12]
 The definitive answer to what causes bipolar is still unknown however, scientists and psychologists continue to research and learn more to find an answer.

Medications & Therapies
There are many ways to treat mental illness. Therapy is usually the first step in treatment. Meeting with a therapist can greatly reduce stress of everyday life by having an output to express your feelings in a positive and productive way.
 Psychotherapy is defined as “The treatment of psychological disorders or maladjustments by a professional technique, as psychoanalysis, group therapy, or behavioral therapy.” [9 ] Psychotherapy can be a very helpful tool in coping with mental illnesses such as bipolar.
The next step in treatment may involve medications. Many people get nervous when they hear they have to be on medications. I know I was but, it’s really nothing to worry about. I was mostly afraid of bad side effects that could happen and while that is always a possibility, the chances of anything serious happening are very slim. For bipolar, many people begin on a medication classified as SSRI’s (Selective Serotonin Reuptake Inhibiters) Such as Celexa, Lexapro, Prozac, or Paxil. [2 ] These medications are highly effective and generally cause fewer side effects than the other antidepressants. SSRI’s help to alleviate symptoms of depression by blocking the reabsorption or reuptake of serotonin in the brain. Serotonin is a naturally occurring neurotransmitter (chemical) that is used by brain cells to communicate.
As SSRI’s mainly affect the levels of serotonin and not levels of other neurotransmitters, they are referred to as “selective.” [2 ]
Other medications have been used to treat bipolar such as Monoamine oxidase inhibitors
(MAOI’s) block the activity of monoamine oxidase, an enzyme that breaks down norepinephrine, serotonin, and dopamine in the brain and other parts of the body. MAOI’s have many drug and food interactions and cause significant side effects in comparison to the new antidepressants.
Tricyclic antidepressants (TCA’s) were one of the first approved antidepressants. Although they are effective, they have been replaced by newer antidepressants that generally cause fewer side effects. Like SSRI’s, TCA’s work by blocking the reabsorption of the neurotransmitters serotonin and norepinephrine in the brain. Additionally, they block muscarinic M1, histamine H1, and alpha-adrenergic receptors. All antidepressant carries a black box warning label. People under certain ages are not recommended to take antidepressants because of a big risk of increased suicidal thoughts and ideation. [2 ]

My Medications & Treatments
I currently go to therapy every week. One fifty minute session with my therapists helps me to relieve and express my emotions which I wouldn’t normally be able to. Aside from therapy, I am also prescribed medications. For my disorders I take Latuda, Seroquel, Adderall, & Paxil.
Latuda (Larasidone) is used to treat bipolar disorder type one. Seroquel (Quetiapine) is used to treat depressive episodes and acute manic episodes in bipolar disorder. Adderall (Amphetamine Salts) is a stimulant used to treat ADHD (Attention Deficit Hyperactivity Disorder) and narcolepsy, a sleeping disorder. Paxil (Paroxetine) is an antidepressant drug of the selective serotonin reuptake inhibitor (SSRI) type. Paroxetine is used to treat major depression, obsessive-compulsive disorder, panic disorder, social anxiety, posttraumatic stress disorder, generalized anxiety disorder and vasomotor symptoms (hot flashes and night sweats) associated with menopause in adult patients. [2]

Coping Skills, DBT, & Mindfulness
When I was in the hospital on the psychiatric floor I learned what coping skills were, how to use them, and how they help. There are many different coping skills but, my favorites come from DBT (Dialectical Behavior Therapy). DBT is cognitive behavioral treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD) and it is now recognized as the gold standard psychological treatment for this population.[10] In addition, research has shown that it is effective in treating a wide range of other disorders such as substance dependence, depression, post-traumatic stress disorder (PTSD), and eating disorders.
Many useful things can be learned from DBT. [10] Mindfulness is another commonly used technique in battling mental illness. The idea behind mindfulness is being aware moment-to-moment, of one’s subjective conscious experience from a first-person perspective. My favorite lesson I learned is that there is four options to every scenario or problem. You can solve the problem, change your perception or how you see the situation, radically accept the situation, or simply stay miserable. [10] Radical acceptance is the hardest of the four in my opinion. The idea of radical acceptance is just accepting any situation, good or bad, as it is. This can prove to be extremely challenging at times.
It requires a lot of patience and practice, but once you are able to stop and notice and be mindful of everything happening around and to you, it gets a little easier to fathom. Radical acceptance has three key lessons, they are:

1. Reality Is what it is.
2. Everything has a cause.
3. Life can be worth living, even when there is pain. [15]

Studies & Research
Many different scientists and psychologists have done an immense amount of studies and research on all types of mental illnesses. New studies and research is always starting, trying to find the cause and best treatment options of mental illness. As well as research and clinical trials of new medications and therapies.
A recent study by Dr. J. John Mann, M.D. considered whether suicidal behavior in a parent gets passed on to children. The study tracked 701 children of 334 people diagnosed with mood disorders for an average of six years to identify factors that predicted suicide attempts among the children. The study found that having a parent who had attempted suicide made it nearly five times more likely that one of their children would make an attempt. [14]

Statistics
Who is Affected by Bipolar Disorder?

Bipolar disorder affects approximately 5.7 million adult Americans, or about 2.6% of the U.S. population age 18 and older every year. (National Institute of Mental Health) [14]

The median age of onset for bipolar disorder is 25 years (National Institute of Mental Health) [14], although the illness can start in early childhood or as late as the 40's and 50's.

An equal number of men and women develop bipolar illness and it is found in all ages, races, ethnic groups and social classes.

More than two-thirds of people with bipolar disorder have at least one close relative with the illness or with unipolar major depression, indicating that the disease has a heritable component. (National Institute of Mental Health) [14]

 

Women and Bipolar Disorder

Although bipolar disorder is equally common in women and men, research indicates that approximately three times as many women as men experience rapid cycling. (Journal of Clinical Psychiatry) [15]

Other research findings indicate that women with bipolar disorder may have more depressive episodes and more mixed episodes than do men with the illness. (Journal of Clinical Psychiatry) [15]

Economic Factors

Bipolar disorder is the sixth leading cause of disability in the world. (World Health Organization) [17]

Suicide and Bipolar Disorder

Bipolar disorder results in 9.2 years reduction in expected life span, and as many as one in five patients with bipolar disorder completes suicide. (National Institute of Mental Health) [13]

Children and Adolescents

Bipolar disorder is more likely to affect the children of parents who have the disorder. When one parent has bipolar disorder, the risk to each child is l5 to 30%. When both parents have bipolar disorder, the risk increases to 50 to 75%. (National Institute of Mental Health) [13]

Bipolar Disorder may be at least as common among youth as among adults. In a recent NIMH study, one percent of adolescents ages 14 to 18 were found to have met criteria for bipolar disorder or cyclothymia in their lifetime. (National Institute of Mental Health) [13]

Some 20% of adolescents with major depression develop bipolar disorder within five years of the onset of depression. (Birmaher, B., "Childhood and Adolescent Depression: A Review of the Past 10 Years." Part I) [7]

Up to one-third of the 3.4 million children and adolescents with depression in the United States may actually be experiencing the early onset of bipolar disorder. (American Academy of Child and Adolescent Psychiatry, 1997) [1]

When manic, children and adolescents, in contrast to adults, are more likely to be irritable and prone to destructive outbursts than to be elated or euphoric. When depressed, there may be many physical complaints such as headaches, and stomachaches or tiredness; poor performance in school, irritability, social isolation, and extreme sensitivity to rejection or failure. (National Institute of Mental Health). [13]



 

Treatment for Bipolar Disorder

Success rates of 70 to 85% were once expected with lithium for the acute phase treatment of mania, however, lithium response rates of only 40 to 50% are now commonplace. (Surgeon General Report for Mental Health) [16]

Participation in a DBSA patient-to-patient support group improved treatment compliance by almost 86% and reduced in-patient hospitalization. (DBSA) [14]

Consumers with bipolar disorder face up to ten years of coping with symptoms before getting an accurate diagnosis, with only one in four receiving an accurate diagnosis in less than three years. (DBSA) [14]

A gender bias exists in the diagnosis of bipolar disorder: women are far more likely to be misdiagnosed with depression and men are far more likely to be misdiagnosed with schizophrenia. (DBSA) [14]

Nearly 9 out of 10 consumers with bipolar disorder are satisfied with their current medication(s), although side effects remain a problem. (DBSA) [14]

Consumers who report high levels of satisfaction with their treatment and treatment provider have a much more positive outlook about their illness and their ability to cope with it. (DBSA) [14]


Mental Illness Stigmas
Stigma is defined as “A sign of disgrace or discredit, which sets a person apart from others.” [9] Mental health has become a very controversial topic. The history of mental hospitals, asylums, and some patients created a label that won’t seem to come off. People with mental illness are perceived crazy and dangerous. However, The absolute risk of violence among the mentally ill as a group is very small. Only a small proportion of the violence in our society can be attributed to persons who are mentally ill. People with psychiatric disabilities are far more likely to be victims than perpetrators of violent crime. [13]
The difference between a normal and a stigmatized person was a question of perspective, not reality. Stigma (like beauty) is in the eye of the beholder, and a body of evidence supports the concept of stereotypes of mental illness. [13] People with mental illness are not “disabled”. I am not “disabled”. I can do anything you can do. I can do anything I put my mind to just like any other person. The only difference between me and the average person is that I’m not able to handle my emotions but, I’m just as able to do things like a normal person. I can write this essay, draw a picture, drive my car, and have friends, just like normal people do.
I believe the stigma of mental illness is wrong and we should all band together to finally put an end to it. It just makes problems worse for everyone involved. It doesn’t feel good knowing there is people I love and hold dearly to my heart, think I’m a crazy psychopath because of this stigma.







Advice
my advice for anyone living with a mental illness is to stay strong and be yourself. Never be ashamed of who you Are. You are a beautiful, unique individual. Mental illness doesn’t make you any less of a person. In fact, in my opinion only the strongest people can battle mental illness and live a positive regardless of their condition.

 

Bibliography

[1] - "American Academy of Child and Adolescent Psychiatry." American Academy of Child and Adolescent Psychiatry (1997): n. pag. Web.

[2] - "Antidepressants." Wikipedia. N.p., n.d. Web. <https://www.wikipedia.org/>.

[3] - "Bipolar Disorder in Adults." National Institue of Mental Health. U.S. Department of Health and Human Services, n.d. Web. <http://www.nimh.nih.gov/>.

[4] - "Bipolar Satistics 1999-2000." Depression and Bipolar Support Alliance. N.p., 2000. Web. 10 Oct. 2015.

[5] - "Bipolar Statistics." Journal of Clinical Psychiatry (2015): n. pag. Web.

[6] - "Bipolar Statistics." National Institute of Mental Health. NIMH, n.d. Web.

[7] - Birmaher, B. N.p.: n.p., 1995. Print.

[8] - Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, D.C.: American Psychiatric Association, 2013. Print.

[9] - "Dictionary." Dictionary.com. N.p., n.d. Web. <http://www.http://dictionary.reference.com/>.

[10] - "Got a Problem? The Good News Is You Only Have Four Options." Psychology Today. Psychology Today © 1991-2015 Sussex Publishers, LLC | HealthProfs.com © 2002-2015 Sussex Directories, Inc., n.d. Web. <www.psychologytoday>.
[11] - "The History of Bipolar Disorder." The Health Line. Healthline Networks, Inc., n.d. Web. <http://www.healthline.com/>.

[12] - "Mayo Clinic." Mayo Clinic. N.p., n.d. Web. 10 Oct. 2015. <http://www.mayoclinic.org/>.

[13] - "NAMI: National Alliance on Mental Illness." NAMI: National Alliance on Mental Illness. National Alliance on Mental Illness, n.d. Web. 10 Oct. 2015. <http://www.nami.org/>.

[14] - "Parent’s History of Suicide Attempts Helps Predict Suicide Attempts In Children." Brain and Behavior Research Foundation. THE BRAIN & BEHAVIOR RESEARCH FOUNDATION, 2015. Web. 2012. <http://bbrfoundation.org/>.

[15] - "Radical Acceptance." Psychology Today. Psychology Today © 1991-2015 Sussex Publishers, LLC | HealthProfs.com © 2002-2015 Sussex Directories, Inc., n.d. Web. <https://www.psychologytoday.com/>.

[16] - "Surgeon General Report for Mental Health." Surgeon General Report for Mental Health. N.p., n.d. Web.

[17] -"World Health Organization." World Health Organization. World Health Organization, 2015. Web. 2015.