Arduous Journey

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None of this is easy, if I have made it appear easy, I apologize for the unintentional duplicity.

Depression is hard, and mine has returned.  It isn’t as deep and dark as it has been, not by a long shot, but I’m not exactly myself either.  To top it off, I’ve been hypo-manic as well – and mixed states are hard to treat.  I’m taking Lithium and Wellbutrin, and balance is returning, but the process is slower than I would like and I can be impatient.  I’m still working, still engaged in life, still involved with my family and friends – and I still very much want to be; that isn’t a facade – I’m not just going through the motions this time, so I know it could be much, much worse than it is; the benefit to having been here before is recognizing the signs quickly, before they spin out of control and drag you into the abyss.

Naturally, because I hadn’t been depressed for a long time, my therapist and psychiatrist began treatment by assessing what had changed in my life; “what were the triggers and or stressors?”  The answer wasn’t immediately clear, but over the last few weeks it has become obvious …

Ed – having Ed in my life is what has changed.  That isn’t bad or stressful in-and-of-itself, but the thoughts and feelings it evokes can be.  I shared with my sister that he is trying now, and I can see it – the things he has done for my daughter are thoughtful and kind and would be for any grandfather, but all I can think of is how different my life would be, how different our relationship would be today, if he had valued me in the way he values building a relationship with her.   And that is just one example …

I still don’t know if people change; I’m beginning to think they just acquire a better mask.  I’ve seen glimpses here and there of the father I remember – a man quite unlike the man he sees himself as today.

Early in our email conversations, he mentioned that he “checked in with me mentally every year or so.”  Aside from not knowing exactly what that means, it baffles me; I am his son, did he not feel a sense of loss?  He also indicated that he “sought therapy for anger” – anger he believed to be directed at me for having ended our relationship … he felt anger with me? I was incredulous.  Then I remembered, and it didn’t take me long – anger was always his go to emotion.  Was he grieving our lost relationship, as any normal father would; did he replace the pain he felt with anger?  Would he even recognize this if it were true?

I don’t buy his not knowing exactly what he did to me, don’t appreciate his inability to look at life as it truly was while he was raising me.  The deeper we get into a new relationship, the more this concerns and bothers me.  I know some things are best left in the past, and I’ve let go of a lot in the months since we began speaking again – but I’m finding that the past is made relevant by today, and that bit of irony can be cruel, messy and complicated.

Rhonda asked me the other night what I wanted from Ed now, and I replied; “I want him to be a dad.” The deeper meaning behind those seven words is this:  I want him to feel something about who he is to me; I want it to matter and to be important to him — I want him to view fatherhood like I do … and that just can’t happen; he has no idea how to be a father, much less a dad.  So I have forgiven him this shortcoming, but I’m still left with a man who makes almost no sense to me.

He has apologized to me, to Rhonda, to our children – and we all appreciate that, but I don’t think he has any understanding of the depth of what he did; how can he?  He refuses to engage, to remember.  He likes who he thinks he is now, facing the monster he was would be hell, but for his apology to have the meaning it should have, he needs to do this.  I need for him to do this – on his own, deep soul-searching – a willingness to face who and what he was.  A willingness to feel my pain, and my sister’s.

And it would mean a lot if he’d do some research, find out how to support a family member with Bipolar Disorder – if my child were diagnosed with an illness, any illness, I wouldn’t rest until I’d become an authority on the subject.  This is what dads do.

Reconciliation is a One Step Up and Two Steps Back process;  many, many stops and starts all predicated on the past as it is reflected in today.

It isn’t easy, it’s more complicated than anything I have ever done before.

Elizabeth

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So I took a deep breath, and emailed my sister this morning.  All the sharing on Facebook last week in connection with National Siblings Day made me think … and today I decided to reach out.

No idea what, if anything, will come of this.

Growing up, we weren’t close – in fact, we were often adversarial.  I’m told that in an abusive home, one of two things will happen; siblings will form an unbreakable bond, or they will have a wholly dysfunctional relationship with each other – we had a dysfunctional relationship; we hadn’t learned from our parents how to relate to anyone, it was all we could do to survive the horror of day-to-day life.

When I turned my back on my parents thirty years ago, I turned my back on Elizabeth, too.  Thus began my twenty-seven year estrangement with her.  Except for a period of time between early 2011 and late 2013, we’ve remained estranged.

I expect nothing, but I do hope she has found happiness.

Child Abuse Information and Prevention

As April is Child Abuse Prevention month, I thought I share this:

A slap: child discipline or child abuse?

Virtually every culture and faith teaches children some version of ‘the golden rule’ – i.e., that you should treat others the same way you would like to be treated. So what are we teaching children when we use physical discipline against them? That resorting to aggression is a valid way to solve a problem? That if someone does something we don’t like, it is OK to hit them?

These questions are too big to be handled thoughtfully in such a brief blog post, but they are questions that many television viewers may be asking themselves, and each other, in light of NBC’s new miniseries, “The Slap,” which premiered in the United States on Thursday 12 February.

The dramatic arc of the show, based on a best-selling Australian novel and series, centers on an adult who disciplines an out-of-control child – not his own son – with a slap during a backyard barbecue. The subsequent drama that unfolds over the course of eight episodes finds family and friends choosing sides, with some agreeing that the unruly child needed a firm hand to be brought into line, and others saying it is never right for an adult to use force against a child. The tightly knit group is soon driven apart by what happens next.

Although this is a fictional story depicted on a small screen, we have evidence to show it represents a disturbing worldwide pattern. Last year, UNICEF released the most comprehensive collection of data on violent punishment of children to date. The numbers starkly showed that violent discipline is the most common form of violence in childhood.

On average, the survey data from 62 countries indicated that almost a billion children aged 2-14 had been physically disciplined in the home in the month before the survey was taken.

Physical discipline, also known as corporal punishment, is defined by the UN Committee on the Rights of the Child as “any punishment in which physical force is used and intended to cause some degree of pain or discomfort, however light.”

About four in five children had been physically punished and/or subjected to psychological aggression while 17 per cent had been severely disciplined (e.g., hit on the head, face or ears or hit hard and repeatedly).

Violent discipline in the home

The effects of many types of violence can be lifelong, and can even be passed from generation to generation. Abundant evidence exists to show how violent discipline is associated with – among other negative outcomes – poor mental and physical health later in life, increased violence and aggression, and damage to family relationships.

One interesting revelation in our data analysis was that many children are subjected to physical punishment even when adults in the household don’t think it is necessary. This gap may seem illogical but it could be explained by the fact that many parents lack alternative, non-violent methods of discipline.

That is why UNICEF promotes strategies such as helping parents, caregivers and families better understand their child’s early development and teaching them about positive parent-child interactions, including non-violent discipline.

One such programme targeted families with children aged 3 to 5-years-old in low-income districts of Istanbul, offering training and discussions on child development and parenting. Two years later, an evaluation found that mothers were communicating better with their children; the children had fewer behavior problems and; incidences of physical punishment had dropped by a staggering 73 per cent. A follow-up study found that, later in life, those children had gone on to do better in school and had more successful careers than children whose families had not benefited from the programme.

accelerating progress graph for Global Report
Global map, Feb 2015On the legislative front, progress is being made towards eliminating all violent punishment of children in homes, in schools and in all other settings. As of the end of 2014, corporal punishment in the home has been prohibited in 44 countries, in alternative care and day care settings in 50 countries, in schools in 122 countries, and in penal institutions in 130 countries.

The pace of law reform is accelerating rapidly, with 10 countries adding their names to the list of those that prohibit corporal punishment of children in the home and all other settings, in 2014 alone. Other governments are also expressing their commitment to reform; at the end of 2014, 45 countries had clearly committed to prohibition.

While this is encouraging news, 91 per cent of the world’s children are still unprotected in law from corporal punishment in the home, and 23 countries lack laws that prohibit corporal punishment in any setting.

Violence is not inevitable. It can be prevented and it is critical to act now to create safe environments for children which allow them to grow up free from fear.

For more information on progress to end corporal punishment in your country, visit: www.endcorporalpunishment.org. For more information on UNICEF’s global initiative to end violence, visit: http://www.unicef.org/endviolence.

 

The Power of Information

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Information and knowledge are power, this is especially true when trying to understand an illness or disease – any illness or disease. Medical professionals, no matter how diligent, educated, competent and compassionate they are can be a limited resource; we get the best care when we ourselves are well informed and actively involved in treatment and wellness.

Long before anyone suspected I was Bipolar, I developed gout – a very painful form of inflammatory arthritis.  I was, at the time, forty years old; fit and healthy.  Even with dietary monitoring, which should have been all I needed, we could not isolate the cause of my acute and chronic flare-ups, so my physician suggested I begin a course of preventative medication.  When I agreed, he gave me a list of possible pharmaceuticals and told me to go home and research them, compare them against my symptoms, and call him when I was ready for him to write the prescription.  I learned a lot through this experience, most importantly to be an informed patient actively involved in my own care and health management.

Information is power; whether you have Bipolar Disorder yourself, or love someone who does, knowledge of the disease is an invaluable asset.  The following links are to some of the best information I have found online – for the patient and his family and friends.

1. bpHope – The single most comprehensive, up-to-date, user-friendly site I have found; solid and useful information on all aspects of Bipolar Disorder.  A great resource.  Follow on Facebook, an easy way to become and stay informed.

2. Mental Health Advocates United – While not specific to Bipolar Disorder, this site is advocacy at its best and most powerful.  Understand and end the stigma.  Follow on Facebook to have daily inspiration appear in your news feed.

3. NAMI – a great place to start your research; broad, general information you can use to target specific aspects of diagnosis and treatment – a spring board for more more in-depth personal study.  Incredibly useful for finding support groups and hospitals in your area.  Legal, financial and social help/tools are just a click away.  Calls for help are promptly returned.  Wonderful, caring people.

Relationships have the best chance of thriving, despite Bipolar Disorder, when family and friends understand the condition and learn to separate the illness from the person they love.  If you love someone with the disease, become informed – for yourself, and them.

If you have Bipolar Disorder yourself, it is vitally important to be informed.  Successful treatment requires your educated involvement – and it means a solid, healthy life for you – and your family.

Subtext

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Ed,

Thank you for understanding why I would find it difficult to speak to you directly regarding the letter on Timothy’s blog, but it is probably even more complicated than you realize.

Nothing about his having Bipolar Disorder is easy, but knowing how and why he has it makes me angry, especially when he is going through a period of imbalance.  These periods are inevitable, they are just part of the illness, but they can be intense and frightening, and they can disrupt our lives pretty completely.

For all that you do know from reading the blog, there is a great deal you don’t know, details we do not share publically; one day Timothy might feel compelled to discuss these things with you face to face, or blog about them, but for now he has decided not to. It is in these terrible truths that I, personally, find the most pain and difficulty separating Bipolar Disorder from the man I love – and this is where my anger with you and Pat is most profound. This is what prompted me to write the letter he posted on his blog.

This latest struggle with the disease, while we were simultaneously interacting with you, was particularly unsettling for me. Right or wrong, I felt in many ways like we were cavorting with the enemy.

My feelings were/are based on Tim’s childhood – the father you were, not on who you are now, or on the father and grandfather you are trying to be today. I appreciate your efforts today more than I could ever tell you, and I enjoy our evenings out – getting to know you and Marie, and so do our children.  More importantly, Tim enjoys this time with you and I would never do anything to change or disrupt that; I will always support his having a relationship with you, even though I don’t understand how it is he is able to do this after everything that happened to him as a child – and everything I know he believes a father must be.

He is a remarkable man, Ed; in all honesty, I couldn’t do what he is doing.  But I see that unraveling his feelings about you, and having a relationship with you today is helping him in ways traditional therapy could not.  So much was left unspoken and unfelt thirty years ago, and this new beginning is in many ways also closure.

I do recognize Pat’s part in all of this cannot be discounted, and I know Timothy believes many of the most heinous acts of abuse to have been committed by her, but I also know you are not innocent, and you bear a great deal of responsibility for all that has happened to him – as a child, and now as an adult facing a terrible mental illness.

My feelings are complicated; I love him more completely than I could ever hope to make you understand, and I have walked through Hell with and for him – I’ve cleaned up the mess you and Pat made time and time and time again, and there is a part of me that wants nothing more in this world than to make you feel ALL the pain you caused, know ALL of the people you’ve hurt – directly and indirectly, understand completely ALL of what you’ve done, and know personally what it cost your children, their children and spouses.

And then logic and reason return to me and I realize … besides being impossible to make you feel and understand, your understanding wouldn’t even be productive – it would change nothing about today; no one can erase the past. But when I am watching him struggle, knowing you caused his challenges, logic and reason fail me, and I always seem to feel the need to make you see clearly what you have done, thus my letter to him about you.

Realistically, and devoid of anger, I hope you will choose to continue being a good father and grandfather today. These are things you can do now; whereas they can’t alter what has been, they have the best chance of easing the pain and ending the frustration for everyone concerned.

Rhonda

Child Abuse Prevention Month

April is National Child Abuse Prevention Month, you can learn more by clicking here.

My wife is having a difficult time coping with the long term effects of child abuse right now – not her own, she wasn’t abused, but what it has done to me, and therefore to our life together.

Child abuse is insidious, and its impact can be felt for a lifetime – and even beyond when you consider its multi-generational legacy; abused children often grow up to abuse their own.

When I look at my own abuse, and where it has led – what it has caused, I’m staggered – so I completely understand my wife’s inability to find the silver lining from time to time …

Her husband has Bipolar Disorder, which has turned her life upside down more than once.

To date, our out of pocket costs for treatment, meds, time off work, etc is about $100,000.

She has seen me behave in ways no wife should ever witness in her husband …

She has been:

screamed at

lied to

threatened

made to feel like a prisoner in her own home

and put into the unenviable position of having to tell me she was leaving, forever, if I didn’t get help.

She has seen me sob like a child …

and laugh maniacally at things that are not humorous.

She has lived through more than I can imagine, or know.

And none of it should be – what happened to me shouldn’t happen to anyone.  It is preventable.  It is all preventable.

So when Rhonda writes me a letter, that I thought should be posted on Silence Shattered, questioning why I am actively trying to forgive my father, I get it.  I really do …

And for Ed, it should be enough to know she will support me in my decision to forgive, reconcile and let go.  After all she has been through because of his reprehensible parenting, that is a lot – kind and gracious and simply remarkable, really.

When you abuse your child, you aren’t causing a moment of pain – you are setting into motion a lifetime of pain, some of which may, eventually, come back to you.

,

Lesson Learned

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I once had a therapist who asked me to try to find a good memory for each bad memory I had of my childhood – I didn’t have near enough good memories to make the exercise productive, so she changed gears:

Find the good that came from the bad …

“I learned who and what I did NOT want to be.”

This answer appeased my therapist, but the wisdom was born of injustice:

Aren’t parents supposed to be role models?

All parents make mistakes, but overall shouldn’t a man be able to look back over his childhood and find far more good than bad?

Aside from feeding me, clothing me and giving me a place to live, I don’t see that my parents felt any obligation at all to their children, which is mind boggling, really.  If you bring a child into this world, do you not bear some obligation for their happiness and emotional well being?

Ideally, what we do for our children we do out of love, concern and caring, but obligation is an absolute inherent to the parent child relationship …

In the sixties and seventies, when I was growing up, parents spanked their children.  Few people stopped to consider whether or not they should, they just did it – it was what they knew because their own parents had spanked them.

My own view on spanking is resolute – it is wrong.  It is a terrible way to instruct and guide because it teaches the child nothing of value, and it is cruel.  You’re also playing with fire; no one knows the emotional breaking point of an individual child – when the pain, emotional and physical, is too much; when discipline, however well-intentioned it might have been, crosses a line and damages the child.  Hitting is wrong – you’d be arrested for hitting an adult, what makes it OK to hit a child?  Aren’t you, as a parent, morally obligated NOT to harm your child, not to cause him pain?

Even with my personal view on spanking falling so close to the extreme, I don’t think I’d have held an occasional, mild, non-humiliating spanking against my parents – as I said, when I grew up spanking was routine …

but we aren’t talking about spanking here, we’re talking about beatings – and not occasional beatings either.

We’re also talking about abandonment, humiliation and neglect of my emotional needs.

I had no idea what I wanted in life, or who I was, because my parents did not help me discover these things – did not live up to their obligation.  Did not love, care for or nurture  …

Seriously, Dear Reader, we are talking about egregiously bad parents here. And their cruelty, neglect and emotional torment led to a lifetime struggle with Bipolar Disorder.

My parents did, however, teach me one thing of value — their actions screamed this lesson at me night and day for the whole of my childhood:

Do NOT be like me.

They did not break the cycle of abuse themselves – far from it, but they did, through their own thoughtless and abusive parenting empower me to do it.

The end does not justify the means;

I am not the kind of man who needed to be taught through cruelty how NOT to be cruel to his own children.

Still, there is immense satisfaction in knowing I am not only better than Pat and Ed …

I am a good, kind and compassionate father.

Transparency and Bipolar Disorder

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Back in January, a friend of my wife’s – someone we have  known for many years, learned I have Bipolar Disorder in a casual conversation she and Rhonda were having about her first husband – a man whose untreated Bipolar Disorder caused their divorce.  When Rhonda shared that she understands, even knows what its like to have a Bipolar spouse, her friend was stunned!  “Tim has Bipolar Disorder? I didn’t know that!  Oh my God, he is so normal!”  Don’t know if I like the word ‘normal’ in this context, but I understood and appreciated her well-intentioned meaning, as did Rhonda.

A few weeks later, a new friend of ours was similarly shocked to learn I have the condition – she and I had become friends while working at the theater company my daughter is involved with, and she, through interaction with me, hadn’t even the slightest inkling that Bipolar Disorder is a part of my life …

and that’s the thing, properly treated and managed, for a most of us, no one outside our immediate family knows because we are just like everyone else in our day-to-day routine, the way in which we conduct ourselves, and in our personal demeanor.

My wife and I decided to stop keeping it a secret some time ago – we used discretion of course, but seeing that people with Bipolar Disorder can and do lead normal lives is a good thing; we all want to end the stigma, and knowing someone who has the disorder,  yet still maintains a fulfilling, happy, productive life goes a long way toward accomplishing that goal.

I said we ‘used discretion,’ and that is probably subject to interpretation seeing as how my entire life can be found on the pages of this blog, and I do not blog anonymously – but using discretion at all is mostly a thing of the past.  When the cause of increasing the awareness of the direct link between child abuse and mental illness became a driving force in my life, I summoned all the courage I had and linked this blog to my personal Facebook page …

then braced myself for the negative reaction I thought would come.

But that isn’t what happened – except for one of my paternal aunts, there has been NO negativity expressed by my friends and family, and I’ve gotten a great deal of support and understanding.  It was hard in the beginning – knowing every word I wrote could be read by real people, people I know and love, not just strangers in the virtual world, but it was probably one of the best decisions I have ever made – for everyone involved.

I think the stigma and bias runs both ways; we, those of us with Bipolar Disorder, expect to be thought of as crazy, or at least less than competent, so we close ourselves off from the very people who care about us most … because we just don’t think they will understand. I underestimated a lot of people, a lot of people whose positive reaction and continued relationship with me I somehow did not expect once they knew I have a mental illness.

I exposed myself for the benefit of a cause I hold dear, a cause I will spend the rest of my life furthering – what better illustration than my own story?

There is no shame in being who I am – and that includes my having Bipolar Disorder.

Shame can be found only in stigma and bias …

and I’ve learned never to assume, or underestimate the capacity for understanding and acceptance inherent in the people who are part of my life.

 

 

 

 

 

 

 

 

 

 

 

Dear Timothy,

This is difficult for me, not because the circumstances are so complex – although they are.  And not because my thoughts and feelings are a twisted, tangled unrecognizable mass I have struggled to unravel and understand time and time again – although this statement is also true. It’s difficult because I love you, and watching you fight to be the man you are – separate from the disease you did not choose, is a nightmare for me.

It would be hard enough for me if Bipolar Disorder had come into your life – our lives, through nothing more than genetic predisposition, but that is far from our reality.  Your parents gave you the disease through years and years of abuse; physical and emotional – and let’s not forget every psychiatrist and therapist you have seen maintains you were sexually abused as well.  So your condition was preventable; for you Bipolar Disorder did not have to be.

For as far as I’ve come, any sort of relapse, however minor it may or may  not be, sends me back to square one in my own ability to cope with your condition.  And my square one is intense anger with the people who caused all of this:  Pat and Ed.

My notion of Ideal Father is you, the man who has loved and nurtured and cared for our children so completely and so well you are, to my mind, the very embodiment of the Ideal.  When I think about abused children, or of children being abused, I am immediately horrified and confused; how could any parent harm their own child? These people, your parents, are the antithesis of you.

I remember the day in the hospital when it all just came pouring out of you.  Pre-illness, I had seen you cry less than a handful of times in our lives, so your sob-laden unburdening was gut-wrenching for me to witness and hear.  Details that sickened me so completely I threw up in heaves in the ladies room before driving myself home.  I had always known you were abused, but until that morning you had spared me the graphic details, and hearing them felt like I had been shot in the stomach – the pain was physical.  At home, I cried harder than I had ever cried before in my life, and I screamed like some sort of wounded animal.  I don’t know how long I laid on our bed in tears, fetal position, trying to process your memories of the terrible things Pat and Ed had done to you.

I do know that when I got up, I was angry.  Actually, I was in a state of virtually uncontrollable fury.  In addition to all I’d heard from you that morning, we had a diagnosis: Bipolar Disorder, Dysthymia, PTSD and Anxiety Disorder – all of which were caused by Severe Child Abuse.  You’d come into this world healthy and whole, and your parents destroyed you.  The people who were supposed to love you, care for you and protect you had caused you such emotional and physical pain they had altered your brain chemistry and set you on the road to mental illness.  The injustice was all too much for me, and I felt vulnerable and powerless in that moment, but I loved you and was determined to help you recover.

In the beginning, I researched like a woman possessed.  I had to find a way to make our lives work for our family.  Finding our new normal took some time, but eventually it did happen.  Occasionally the illness would find its way into our day-to-day lives, but we were learning to cope as a family and happiness returned.  Nothing has destabilized our lives in the way the initial breakdown did, but minor relapses are inevitable and we’ve not escaped them entirely.

Although challenging for me always, your relapses were easier for me to cope with prior to Ed coming back into our lives.  It isn’t Ed as he is now; old and harmless, its knowing what he was and what he did to you, a helpless child — HIS OWN HELPLESS CHILD, that torments me now.  From afar physically, and at a distance in time measured in decades, I had found a home for my anger with him; it isn’t that I wasn’t angry, I was, but he’d been cut out of our lives like a cancer so long ago I simply thought he’d paid the ultimate price for what he had done; he had no contact with you, his only son, and he’d never even met his grandchildren.  That is a terrible price to pay – I cannot begin to imagine not seeing my children, not being permitted to know the grandchildren I will one day have; if that were to be my future, I’d say kill me now, truly, because I Know I could not live with the pain.

But Ed doesn’t feel that pain, and I don’t think he ever did.  God help me if I’m wrong, but he feels no pain at all in knowing what he did to you, or what it has caused; no pain at all in decades of estrangement.  He said words you told him he had to say so he might know you today, but there is no emotion behind them from what I can see. He doesn’t know or understand what it means to be a father, doesn’t feel – has never felt the pain of his child.  My God, he knows how emotionally ill Elizabeth is, or has been – has he reached out to her?  Has he offered her the apologies he owes her?  Whether she wants them or not, she deserves them.  Has he done this?  He says he intends to, but when?  What has he EVER done right as a father?

Last week, when you told me you were actively trying to forgive Ed, I was shocked; stunned beyond belief.  You went on to explain that you understand forgiveness to be for you now, but what about your principle; Child Abuse is Unforgivable?  I cannot imagine how difficult all of this is for you today.  How do you reconcile Ed with your concept of what it means to be a father?  A father, to your way of thinking, is full of integrity, patience and wisdom.  A father loves his child unconditionally.  A father would lay down his life for his child.  A father teaches, nurtures and guides.  A father pays for lessons and classes and college – supports his child’s dreams and aspirations so his child can discover who he is and learn to take care of himself in this world.  Is Ed ANY of that – has he done ANY of that?  He does not deserve you as a son.  He doesn’t.

Right now, because now has seen you struggle a bit, I cannot help but think of everything I know he did to you.  I hear your screams and pleas not to be beaten, even though he never did.  I understand you never really had a father, only a tormentor.  I see where his inadequacy led.

I will find my footing again soon enough, and I support you fully in forgiving your father even though I don’t think I can.  It’s hard for a wife to see her husband as a broken little boy, especially when that little boy grew up to be you, the most wonderful man in the world. You are a hundred times the man he will ever be, and as a father there can be no comparison – you are a father, he never has been.  What you have accomplished in your life amazes and staggers me, because you did it ALL on your own.

If you want Ed to be a member of your family, he will be part of mine – that’s how this works.  I will be gracious and giving, understanding, polite and cordial, but I will never believe he deserves you.

You have said so many times, ‘This isn’t about blame, it’s about knowing why and understanding.’  I see how true that is for you, how good and decent a man you are, but I struggle not to blame, and often I fail.  I am sorry.

You have never believed that people change – you’ve always believed they can change, but never that they actually do.  Do you still believe this?  Has Ed changed?  If you were five years old, would you feel safe in his care?   If our children were little, would you leave them alone with Ed?  These questions haunt me now; they are probably unfair of me to ask you, but I need to know your answers.

I don’t know Ed, I have never known Ed; I know only what I’ve been told, and none of that has ever been favorable.  Everyone from Pat to his girlfriend to a client of my mother’s – people I don’t know or scarcely know, warned me about him when we were dating, and now I know exactly what he did to you – help me understand why we are here.  Please.  Tell me you believe he is no longer a man who would hurt his  own child.  Tell me that and I’ll believe it, too.

This is all so hard for me, and I know Ed is trying – I truly do see it, but it doesn’t change the past.  Injustice, feeling vulnerable and powerless has always been next to impossible for me to process, and I’m angry because Ed, in my  knowing what he did to you, makes me feel all three. I feel twisted and torn and like I have to protect you somehow.  Ostensibly I know this is absurd, you are a grown man, and he is an old man, but I just can’t shake the feeling.

Has he been honest with the people in his life now?  Did he tell his sister the truth when she attacked Rachael, or did he take another, easier road to resolution?  Did he blame you?  Did he blame Bipolor Disorder and what Laura ignorantly believes to be true? Did he defend you by telling her the truth  about what he did to you, regardless of whether or not she would believe it?  Or is he a coward?   I need to know what you think and what you feel about all of this.  Your feelings are real, valid and they do matter.  They always have, even when your parents told you they didn’t.

You say I am your rock and your support, that you couldn’t do this – successfully manage Bipolar Disorder without me, but the truth is this:  you are my strength, even when you were desperately ill you were my touchstone and my life.  I simply adore you.

Help me understand Ed as you do, help me to see your reasoning in giving him this precious second chance.  I need to know how and why you feel as you do.

I have loved you since the beginning of time, and I will love you until the end,

Rhonda

For Pat and Laura and Possibly Ed, too

This is, without a doubt, the best article I have ever encountered to explain how Bipolar Disorder impacts memory.  Ah, the power of factual information — no mention what-so-ever of False Memories.  That’s because all those things you said didn’t happen, actually did.  ***In fact, it seems our memory is far, far better than yours.*** 

***”Things like remembering events and life experiences, for example, are recalled with savant like accuracy.”*** 

 

The cognitive connection

Feeling scatterbrained? Can’t remember a thing? It may be “bipolar brain fog”—and you can manage it.

 

By Jamie Talan

 

“I’m the PhD down the hall whose memory fails during critical discussions at the office,” says Debra.

Debra, 48, is a behavioral scientist with the Centers for Disease Control and Prevention in Atlanta. She leads research and oversees a team of data analysts in the Division of Violence Prevention.

Before her bipolar diagnosis six years ago, she sometimes had trouble keeping focused. Now recall is a bigger problem, especially if she’s expected to dredge up dates or statistics during a meeting or keep track of details after an impromptu encounter.

“I ask people to schedule meetings rather than have these hallways conversations when we need to make decisions,” she says.

In meetings, she takes copious notes to jog her memory.

“I scribble as fast as I can … sometimes so fast I can’t read my own notes,” she reports. “I just have to chuckle when, ‘This research should move ahead,’ turns into, ‘This rabbit should go to bed.’”

Psychiatrists and researchers are coming to appreciate that memory lapses and other neurocognitive problems—disorganization, groping for words, difficulty learning new information—can go hand in hand with the more obvious mood and behavioral symptoms that characterize bipolar.

Joseph Goldberg, MD, a psychiatrist and associate clinical professor of psychiatry at the Mount Sinai School of Medicine in New York City, helped put these “thinking” problems on the bipolar map. He’s co-editor of Cognitive Dysfunction in Bipolar Disorder: A Guide for Clinicians, which came out in 2008.

Goldberg says the book builds on “literally hundreds of studies” analyzing aspects of cognition in patients with bipolar disorder.

He mentions an influential Spanish study, published in the American Journal of Psychiatry in February 2004. In every phase of the illness (depression, mania and remission), researchers found marked deficits in verbal memory and what’s known as “frontal executive tasks.”

Think of it this way: The brain is organized like a big office with specific departments designated to complex tasks such as decision-making, attention, verbal memory, spatial memory, motor speed and skill, and logical reasoning.

The frontal lobes of the brain contain circuitry that acts, in essence, like a hardworking executive secretary. Information comes into the frontal lobe and the secretary notes it, organizes it, and sends out messages to the brain’s different departments to get things done.

Faulty processing in this executive center can lead to cognitive deficits that affect awareness, reasoning and judgment, Goldberg says.

The hippocampus, meanwhile, serves as a kind of file clerk for recording new memories and sending them on to permanent storage. Bipolar has been associated with shrinkage of the hippocampus, which may explain difficulties in acquiring and accessing various kinds of data.

Goldberg notes that many aspects of intellectual functioning carry on just fine in people with bipolar— even better than in the general population. ***Things like remembering events and life experiences, for example, are recalled with savant like accuracy.***  The glitches are limited to specific areas: verbal memory, executive organization, “processing speed” and attention.

 

Daily difficulties

Attention—the ability to focus on a task or conversation, tune out distractions, and, ultimately, filter information into working memory—is the gateway to learning, memory and other higher cognitive processes, says Frederick Goodwin, MD, a leading clinical researcher on bipolar disorder who is now based at George Washington University.

All of those functions can go haywire during depression and mania, of course. In fact, manic symptoms can mimic attention deficit hyperactivity disorder (ADHD).

I could do a million things at once and do it well… [Now] I’ve learned I can focus on one thing and do that.

On the other hand, ADHD occurs “at rates substantially greater than the general population” in individuals with bipolar and major depressive disorder, according to researchers with the Canadian Network for Mood and Anxiety Treatments.

Their treatment recommendations, published in the February 2012 issue of the Annals of Clinical Psychiatry, note the importance of accurate diagnosis and careful pharmacotherapy, since some ADHD medications can trigger mania. Mood stabilization should come first, they write, before addressing ADHD symptoms.

But what about scattered attention, memory glitches and other cognitive deficits that practitioners never hear about from their patients with bipolar?

Goodwin notes a change in thinking since Manic-Depressive Illness, the now-classic textbook he wrote with Kay Redfield Jamison, came out in 1990. Not more than a decade ago, he says, professionals checked off a host of mood and behavioral symptoms and didn’t pay much mind to cognitive factors.

It didn’t help that the problems can be subtle and unlikely to show up in an office interview—especially when verbal ability remains sharp.

Cognitive deficits can be subtle or severe, but studies show that as many as a third of people with bipolar I have cognitive problems that disrupt their lives.

Bipolar brain fog can complicate everything from succeeding in school to paying the bills. Rick of Saskatoon, Saskatchewan, is less confident behind the wheel these days because of “near misses and some dents.” He blames poor concentration and slowed motor skills.

“I used to pride myself on being an excellent driver,” says Rick, 62, who crisscrossed the continent during his 25 years as a communications specialist in the Canadian Forces. “I didn’t even get any tickets.”

Rick says predominantly high moods helped him succeed socially, in sports and in his career. With time, however, he began to notice it was harder to follow a train of thought. Loud talking and other noise made it tough to focus on what he was doing.

His coordination also deteriorated, leaving him with a tendency to lose his balance on a ladder, stumble while walking, or nick himself when working with tools. Escalating mood shifts led to his bipolar II diagnosis a few years ago.

Rick still captains the car on local errands, but it helps to have his spouse on board as navigator, noting where to turn or when to slow down. As a military wife, she managed the family and handled all the relocations; now more than ever, Rick says, she’s “the decision-maker and my assistant.”

In addition to checking in daily with his wife to make sure he hasn’t overlooked any obligations or appointments, Rick follows a routine that includes activities in the morning when he feels most alert, a nap in the afternoon when energy and attention flag, and a strictly regimented bedtime.

“It’s a long journey,” he says of learning how to manage his fluctuating symptoms, “but I believe that hope is the best car to drive in.”

 

Complicated causes

The fact that neurocognitive problems linger after symptoms subside—and can be present before a bipolar diagnosis is made—makes scientists think that these disturbances are a core and consistent feature of the illness.

A Canadian study that appeared in the Journal of Clinical Psychiatry in September 2010 found that attention, recall, and several aspects of executive functioning were compromised even at onset of the first manic episode.

Researchers are trying to learn more about what areas of the brain are vulnerable to the disease process and what role the course of illness plays.

Moira A. Rynn, MD, an associate professor of clinical psychiatry at Columbia University Medical Center, is involved in a multi-center study on pharmacological treatment for adolescents that includes a detailed cognitive battery given at baseline and again every two years.

Goldberg notes that most aspects of intellectual functioning carry on just fine in people with bipolar- even better than in the general population.

Rynn says it can be difficult to assess cognitive impairment in a “snapshot” evaluation because individuals come with their own set of cognitive strengths and weaknesses. A “longitudinal” study such as she is doing can reveal whether each participant’s learning difficulties get better or worse, and shed light on why.

“There is a need to do careful standardized assessments over time, controlling for the type of treatments given,” she says. “We do need to know whether the severity and frequency of episodes make cognitive problems more severe, and what is the impact of medication treatment over time.”

Goodwin says that while the pathological underpinnings of the disease itself may play a role in cognitive problems, there are a number of other explanations to consider. All kinds of medications can affect the brain regions that control cognitive function. So can medical illnesses such as fibromyalgia and cancer, drug and alcohol use, anxiety, and stress.

Sue Marsh (not her real name) is a walking example of that interplay. Marsh, 59, recalls that learning was difficult for her as a kid. She was diagnosed with adult attention deficit disorder in her 30s. Still, she was driven to excel right through graduate school, then as a speech pathologist, and later in medical sales. She made good money and balanced a busy career with raising a family.

Her divorce in 2002 led to depression. When she went through chemotherapy for breast cancer three years later, the treatment apparently triggered bipolar symptoms. Her diagnosis and treatment changed accordingly.

Now, seven years later, she frequently gets lost when she leaves the house. She can’t get out the door without reading dozens of slips of paper that line a path from her bathroom to the kitchen to the door that will send her out into the world. Some of the notes read: Brush teeth. Take pills. Find keys. Find phone. Put coat on. Lock door.

“I just can’t function the way other people do,” says Marsh. Without the notes throughout her house, “I don’t know how I would even get out in the morning.”

Every brain scan and neuropsychiatric report spits out the same result: problems with executive function. She is now on disability. Three words on a note card by the door remind her: Keep it simple.

“I’ve had to revamp my dreams,” she says.

 

Working it out

Those who remain employed may have to work a little harder. Kyle, 33, says friends used to call him Superman because, “I could do a million things at once and do it well.”

He discovered the hard way that he needs to stay on medication to stave off psychosis and extreme behavior. He was fired from his previous job during a bout of unrecognized mania—although to this day, he can’t remember anything that happened during the episode.

Now the effortless multitasking of hypomania is a thing of the past. He’s made accommodations to handle his responsibilities as a production engineer at a small medical device company in Bloomington, Indiana.

Three words on a note card by the door remind her: Keep it simple.

“I’ve learned I can focus on one thing and do that,” he explains. “I have to consciously think, ‘This is what I’m doing, this is what I’ve done, and this is what I’m going to do when I get back to it.’”

Because he can’t keep all the balls juggling in his head anymore, he makes sure to note appointments on his calendar and jot down reminders about important tasks.

Kyle says he was upfront about his altered abilities when he was hired nearly two years ago, but he’s done well enough to win his supervisors’ support. During a recent psychiatric hospitalization, he says, the firm’s owner came by to let him know his job was waiting.

Debra, the CDC scientist, is also happy with the feedback from her superiors. In any event, she says, her bipolar diagnosis at 43 was a life-saving discovery—a fair swap for the slowdown of a few brain cells.

“It’s one of those side effects I have to deal with,” she says, “because I’m not going to stop taking the medication.”

Despite her positive evaluations, Debra admits to feeling incompetent at times because of her quirky memory. Still, she says, living with bipolar disorder also has its advantages. For Debra, lifelong traits such as creativity and increased productivity far outweigh the downside of her lapses.

“It’s about finding your strengths,” she says, “and capitalizing on them.”

 

 

Sidebar: Seeking solutions

As new evidence emerges about cognitive deficits associated with bipolar disorder, clinicians are more apt to take such problems into consideration during evaluation and treatment.

A number of neuropsychological tests are proving helpful in identifying problems that can make everyday functioning difficult. Some tests are designed to pick up misfires in memory and attention, while others measure planning skills and “response initiation”—that is, how quickly and appropriately someone responds to stimuli.

Ivan Torres, PhD, a clinical associate professor of psychiatry at the University of British Columbia whose research focuses on cognition in bipolar, says that cognitive test scores correlate with how well people with bipolar are able to function in the real world.

What to do with the information is less clear.

“We are just in the beginning stages of identifying ways to help patients with these cognitive problems,” Torres says.

Current research is looking at the possible benefits of certain medications, cognitive remediation therapy, and rehabilitation interventions used with brain injury and stroke patients.

“At the very least,” says Torres, “we are in a position to provide education to patients about the cognitive difficulties that they may experience, and to come up with strategies for working around these problems in daily life.”

Breaking complex tasks into smaller units, making the environment less distracting, and creating structure around daily duties can counteract deficits in focus and organization, he says.

Cues, prompts, reminders, and repetition can help with learning and memory problems.

In his work with patients whose memory is unreliable, psychiatrist Joseph Goldberg recommends similar tactics: sticky notes, appointment calendars, and a technique called “chunking”—splitting information into bite-size pieces that are easier to remember.

Betty of Port McNicoll, Ontario, relies on her cell phone. Her son originally gave her a phone with a keyboard so she could save money by texting him rather than calling. She discovered other benefits.

“My phone has a calendar in it, so I just started using my phone to set off a reminder that I had to do something or go somewhere. I even use it to wake me up in the morning,” she says.

After two decades of disabling depression and untreated hypomanic symptoms, Betty got a new doctor in 2010 who gave her a bipolar diagnosis. Now 65 and stable, she says she’s “always had problems with my cognitive abilities. It’s just gotten worse as I’ve got older.”

In her low-tech days, she says, she would miss appointments and forget that she was supposed to meet someone or pick something up—even with “my pieces of paper to remind me” and a calendar in her purse.

“The phone works a whole lot better,” she says.

Betty also adopted a counterintuitive therapy: the game of bridge, which favors players who can keep track of which cards have been put down. Somehow the mental exercise strengthens her erratic memory, she reports.

Her involvement with the game has been so successful, she says, “I not only play it, I teach it.”