A New World and Me Too

Image result for quotes a change is coming

 

It’s been a while since I updated here, but the recent trend in outing men with a past that includes sexual assault, sexually inappropriate behavior, sexual abuse and misconduct is relevant given my having exposed Ed here …

Society is changing, redefining acceptable and unacceptable at a furious pace; gone forever is the naive notion that what happened in a man’s past has no bearing on today.  A man’s past has always mattered; people do not change – finally recognizing this as a collective can have only positive impact on society.

The solution, at least for now – in the early days of this revolution, remains exposure …

When I was about twenty years old, Ed won a cruise for selling a specific number of insurance policies, and he took me with him on this vacation.  The entire ship was filled with insurance agents who had sold the requisite number of policies, as well as their guests.

There was a woman – this is better than thirty five years ago, so I do not recall her name, but she was the guest of a colleague of Ed’s.  During the cruise, she became deeply offended by Ed’s unwanted touching – he would put his arm around her in group photos, try to hug and kiss her when she came to dinner, or when he saw her on excursions.

I told him to stop, that he was making her extremely uncomfortable, but he wouldn’t listen to me, and he didn’t stop.  She finally spoke up, after suffering through several encounters with Ed, and he thought she was, “extremely rude.” She did nothing but set him straight.

My wife’s own “Me Too” moment was given to her by Ed; just like the woman on the cruise, Ed was always touching and trying to kiss her …

and when I told him to stop, that his unwanted affection was making her uncomfortable, he acted as though she had the problem; he was, after all, only being friendly and polite.

Men like this do not alter their behavior, because they do not believe they are the problem.

Decent people have the right to know when they are exposed to those with a history of sexual misconduct. It’s that simple …

so tell your story, and hold them accountable.

A man’s past is an accurate prediction of that same man’s future.

 

 

 

 

 

 

 

 

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.

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

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.

 

 

 

 

 

 

 

 

 

 

 

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.”

 

Righteous Loathing

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Last Friday, as she sat with me waiting to see my psychiatrist, my wife reminded me of a few things – most importantly, it’s not my fault.

I take full responsibility for my actions, I always have, but the illness that drives my compulsions was given to me – by my  mother.

Even when we have moved on, and left the past behind, our subconscious remembers – mine remembers, and it can impact my thoughts, behaviors and choices today.  It doesn’t ask for control, because of Bipolar Disorder it just takes it – and my subconscious is the remnant of a terrified and tortured childhood, and that is reflected in my depression and mania.

I am sorry for the pain my mother inflicted on her sister in throwing her away, but it gave me much needed confirmation; I was right about Pat all along …

A woman who can abandon her children is capable of anything.

And …

Being her son is a life sentence.

Even when I am doing well, as I usually am, I’m not who I was born to be – years of physical and emotional abuse, neglect and abandonment killed that child as surely and effectively as if my mother had strangled me in my sleep.

The guilt and shame associated with having Bipolar Disorder is profound – we do things we should not do.  We say things we should not say.  We hurt people we love deeply and completely …

I take my obligation to remain well seriously, but even the best intentions don’t always produce the desired result …

So my wife reminds me:

It isn’t my fault

I am a good person

I am an amazing, incredible and wonderful father (her words, echoed by our children)

I am a loving and supportive husband

Despite all the pain my mother caused me, she did not make me like her …

a bad parent.

And that’s a win!

Bipolar Disorder and Memory

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Bipolar Disorder is a brain chemistry disorder – a chemical imbalance.  And it does impact memory, but not in the way some people seem to think it does …

You can casually read the results Google returns for your query, and depending on your search terms find the phrase, ‘Distorted Memory,’ associated with Bipolar Disorder, but ‘Distorted Memory’ isn’t the same as False Memories, or Distorted Memories.

Distorted Memory refers to deficits in executive function; i.e., memory storage and retrieval.  

Bipolar patients have difficulties with short-term memory, and may have difficulty accessing long-term memories – we also experience difficulties in concentration; cognitively, our memory can be compared to that of someone who has suffered a stroke.

When I was sick, I was asked a simple question related to my career – a question whose answer I had known for more than twenty five years, about a concept I had literally been teaching to other people for more than five years, and I COULD NOT answer it.  I could not retrieve the information I KNEW was stored in my brain.

Conversely – if, during the same phase of my life, someone had tried to teach me this information, I probably could not have learned it, stored it, or even understood it, despite my foundational knowledge and expertise.

Distorted Memory … not DISTORTED MEMORIES. 

As for False Memories … that isn’t even a real thing as far as credible members of the psychiatric community are concerned.  False Memory Syndrome is a phenomenon largely attributed, and attributable, to unscrupulous therapists.  It has NOTHING to do with Bipolar Disorder.

Incidentally, we collectively – as in every human being on the planet whether they have Bipolar Disorder or not , are far more apt to ‘falsely’ remember and perceive our lives as better than they actually were, not worse …

Which is terrifying for people like me, because I remember my childhood being the stuff of nightmares.

The Link Between Child Abuse and Mental Illness

Harvard Research Study:

Child maltreatment has been called the tobacco industry of mental health. Much the way smoking directly causes or triggers predispositions for physical disease, early abuse contributes to virtually all types of mental illness.

Now, in the largest study yet to use brain scans to show the effects of child abuse, researchers have found specific changes in key regions in and around the hippocampus in the brains of adults who were maltreated or neglected in childhood. These changes leave victims more vulnerable to depression, addiction and post-traumatic stress disorder (PTSD), the study finds.

Harvard researchers led by Dr. Martin Teicher studied nearly 200 people aged 18 to 25, who were mainly middle class and well-educated. They were recruited through newspaper and transit ads for a study on “memories of childhood.” Because the authors wanted to look specifically at the results of abuse and neglect, people who had suffered other types of trauma like car accidents or gang violence were excluded.

Child maltreatment often leads to conditions like Bipolar Disorder, depression and PTSD, so the researchers specifically included people with those diagnoses. However, the study excluded severely addicted people and people on psychiatric medications, because brain changes related to the drugs could obscure the findings.

Overall, about 25% of participants had suffered major depression at some point in their lives and 7% had been diagnosed with PTSD. But among the 16% of participants who had suffered three or more types of child maltreatment  — for example, physical abuse, neglect and verbal abuse — the situation was much worse. Most of them — 53% — had suffered depression and 40% had had full or partial PTSD; 38% had received a diagnosis of Bipolar Disorder.

The aftermath of that trauma could be seen in their brain scans, whether or not the young adults had developed diagnosable disorders. Regardless of their mental health status, formerly maltreated youth showed reductions in volume of about 6% on average in two parts of the hippocampus, and 4% reductions in regions called the subiculum and presubiculum, compared with people who had not been abused.

That’s where this study begins to tie together loose ends seen in prior research. Previous data have suggested that the high levels of stress hormones associated with child maltreatment can damage the hippocampus, which may in turn affect people’s ability to cope with stress later in life. In other words, early stress makes the brain less resilient to the effects of later stress. “We suspect that [the reductions we saw are] a consequence of maltreatment and a risk factor for developing PTSD following exposure to further traumas,” the authors write.

Indeed, brain scans of adults with depression and PTSD often show reductions in size in the hippocampus. Although earlier research on abused children did not find the same changes, animal studies on early life stress suggested that measurable differences in the hippocampus do not arise until adulthood. The new study finds that the same is true for humans.

The findings also help elucidate a pathway from maltreatment to PTSD, depression, Bipolar Disorder and addiction. The subiculum is uniquely positioned to affect all of these conditions. Receiving output from the hippocampus, it helps determine both behavioral and biochemical responses to stress.

If, for example, the best thing to do in a stressful situation is flee, the subiculum sends a signal shouting “run” to the appropriate brain regions. But the subiculum is also involved in regulating another brain system that, when overactive during chronic high stress such as abuse, produces toxic levels of neurotransmitters that kill brain cells — particularly in the hippocampus.

It can be a counterproductive feedback loop: high levels of stress hormones can lead to cell death in the very regions that are supposed to tell the system to stop production.

What this means is that chronic maltreatment can set the stress system permanently on high alert. That may be useful in some cases — for example, for soldiers who must react quickly during combat or for children trying to avoid their abusers — but over the long term, the dysregulation increases risk for psychological problems like depression and PTSD.

The subiculum also regulates the stress response of a key dopamine network, which may have implications for addiction risk. “It is presumably through this pathway that stress exposure interacts with the dopaminergic reward system to produce stress-induced craving and stress-induced relapse,” the authors write.

In other words, dysregulation of the stress system might lead to intensified feelings of anxiety, fear or lack of pleasure, which may in turn prompt people to escape into alcohol or other drugs.

With nearly 4 million children evaluated for child abuse or neglect in the U.S. every year — a problem that costs the U.S. $124 billion in lost productivity and health, child welfare and criminal justice costs — child abuse isn’t something we can afford to ignore.

Even among the most resilient survivors, the aftereffects of abuse linger forever. Not only are such children at later risk for mental illness, but because of the way trauma affects the stress system, they are also more vulnerable to developing chronic diseases like metabolic syndrome, diabetes, high blood pressure, heart attack and stroke.

We can do better for our kids.

The study was published in the Proceedings of the National Academy of Sciences.

Written by Maia Szalavitz for Time;  Health and Family