Saturday, June 29, 2013

Revisiting some probing questions

Laura Dennis graciously hosted me on her blog, The Adaptable (Adopted Mommy Expat on Fridays, June 14, 21, and 28. She asked me a series of questions about my book, Leaving the Hall Light On, my son Paul's bipolar disorder and suicide, and my grieving and surviving process. I think her probing questions are worth repeating and showcasing here.

On Friday June 14, she asked:

Are There Early Indicators for Bipolar Disorder?

Laura writes, "The death of a child is unfathomable. The suicide of one’s young adult child after his suffering through years of a mental illness? Awful beyond words. … Painful to the point of, How do I get beyond this and not kill my own self? … Devastating, like, I’ll just live on anti-anxiety pills for the rest of my life. 

Which came first, the bipolar or the stress?

Laura – Paul–your eldest son and the one you lost to suicide, was a creative, gifted musician.
In trying to make sense of his death, you discuss events that could have indicated he was bipolar (or at least had an inherited tendency towards it), and life experiences that may have triggered the disorder’s onset.

With the emergence of bipolar–family history vs. stress … It’s almost a chicken or the egg question.

Whether the cause is a chemical imbalance in a still-maturing late adolescent brain, or rather the stressful experiences of that particular life phase (finding independence, first loves, embarking on a career) …  we may not know exactly.
You spend a large part of the first sections of your memoir, Leaving the Hall Light On,exploring these questions. Can you talk a little about what indicators you could have seen at the time–had you known more about bipolar disorder?

Madeline – Probably the first indicator was his reaction to the possibility that my husband would take a job on the East coast and move us away from where he grew up and was going to school. We actually went into family therapy about it, and Paul ended up staying with that therapist on his own for about a year. The job change didn’t happen so Paul was relieved, but as a result he became quite introverted around the house.

Other indicators: he was anal about his things, he was very tender after the older woman broke up with him, he was a night owl, though he walked a lot he didn’t get much exercise or eat very well, he was an underachiever in academics and an over achiever in music.

Another thing that should have indicated he had a problem outside the normal was an incident that happened while he was home for holiday, just a couple months before his first manic break: he became quite upset because his brother Ben had decided to exchange bedrooms with him at our home. Ben thought he wouldn’t mind because Paul had clearly let us know he wouldn’t be returning to California after he graduated from the New School in New York City. Paul minded very much and behaved quite irrationally about it.

Emotional triggers and bipolar disorder

Laura — I want to talk a little about triggers. As a teenager, Paul’s first lover was a much older woman. You mentioned–and I completely agree with you–that this inappropriate relationship made a huge impression on Paul, emotionally immature by comparison. I think the effect of this relationship on Paul is not to be discounted. It affected his later relationship with Janet, a woman his own age, who you deeply admired. Paul just couldn’t get it together with her; he had unrealistic expectations. He loved Janet deeply, but as Janet said to him: he loved not taking his medications more.

Madeline – I kick myself still about not reporting the older woman to the police. She was a child molester. But I worried I would lose my son as a result.
In those days he acted way older than he actually was so he always had an answer for everything. The other thing–something not in the book–is that he got her pregnant twice. The first time at his urging and of course our agreement, we paid for the abortion. The second time she aborted spontaneously, and he was very upset about it. Those situations weighed very heavily on this boy–just seventeen and eighteen at the time. It is no wonder we thought of Janet as his savior. Unfortunately, in the long run, Janet couldn’t go through another one of his manic episodes. When she found out he wasn’t taking his meds, she needed to move on.


On June 21, Laura delved into questions about:

Is it bipolar or not? Is it stress? Does he just in need of a good night’s sleep? Maybe she’s simply high-strung and likes to talk fast.  

She said, “Madeline talks a lot in her book about Paul’s musical ability, his creativity. And truly, not everything about bipolar disorder is bad. People with BPD have an amazing capacity at empathy and can connect with others on a deep level. They are often very artistic and creative. It’s just that the disorder is a double-edged sword: that empathy can lead to depression–feeling too much. Creativity and multi-tasking can quickly go from productivity in hypomania to delusional, sleepless mania. Knowing how to keep it in check is a life-long task and requires help from friends and loved ones.” 

Is it possible to manage bipolar tendencies?

Laura — My diagnosis was: well, you had a bipolar episode. If you have another episode, then you’re definitely bipolar. And my psychiatrist scared the living shit out of me saying that if I do have another breakdown, it’s going to be worse and it’s going to require a longer hospital stay.

I’m trying to figure out what was/is the difference between Paul and me.
I too liked being manic, but after my breakdown, I understood it’s not in fact a sustainable state. Over time, with therapy, proper diet, exercise and sleep I learned to manage my bipolar tendencies without medications. I can let myself become hypomanic, and in this state I can be very creative and productive, but I refuse to let myself go into the mania.

The mania is not truly a productive, creative state–it’s a destructive state. For me, it leads to paranoid delusions, hallucinations and really bad headaches.
What I want to know is … Is it a guy thing? Like, I was always a type A, perfectionist, people-pleaser, and I realized I’d be letting too many people down if I let myself have another breakdown. Was it catching it soon enough? (There’s also the possibility that I don’t have bipolar at all, but I doubt that’s true.)

Madeline – I think you’re lucky to be able to manage your bipolar tendencies. Paul tried all of that toward the end of his life – he even quit smoking – and I think he was doing well. He also worked every day at a very tedious and intellectual job, while successfully hiding his illness. But when Janet broke up with him all bets were off. That may truly be a guy thing. Kay Jamison says if you’re a young man, if you have bipolar disorder, and if a loved one leaves you, you are a candidate for suicide.

Also, almost two years passed between Paul’s first and second breaks. And he was off of medication most of that time. He graduated college and worked part-time jobs and played music gigs. He was doing so well, we all thought his diagnosis must be wrong. But when the second break started, at first with hypomania, it came on very strong and very fast. We brought him home from New York, but his behavior was hell for all of us until he was hospitalized again and resumed taking his medications.

I also don’t think he had a concern about letting people down if he had another breakdown. Paul was always a selfish guy. I think he just did what he wanted without taking our feelings into consideration. Maybe it’s your nurturing instinct that works in your favor – something Paul and maybe other guys don’t have.


On June 28, we discussed 

Death by Suicide – What we can learn about overcoming grief. 

Laura was curious as to how I overcame my grief–without prescription drug abuse, drowning my sorrow in alcohol, or ending up destroying my marriage.

Laura — I was very much enthralled with your description of your personal grieving process, how you naturally gravitated toward fully experiencing the horrific loss of your son, without going into denial or relying too heavily on coping mechanisms. Even as you were “pretending” to live–go out, work, exercise, socialize, you allowed yourself time to cry and feel sad. But over time, that pretending reminded you that you have so many things to live for, and that you could enjoy your life and remember Paul.

Madeline – My coping mechanisms were my working out, working, and writing. It’s as simple as that.

And now after almost fourteen years since Paul’s death I’m still using them – almost to the point of obsession. But they keep me sane and grounded. They keep me whole. Yet they don’t stop me from still having guilt and regrets, missing him, wondering what I could have done to save him.

Laura — Another aspect of your healing process was that you ended up doing it without support groups, without therapy and without religion.
But surprisingly, one tangible thing that seemed to provide some solace was the small, smooth stone with the word “son” etched into it. I’ve written before about grounding tools–small objects that can be used to keep a person from detaching and dissociating. For you, what purpose did this stone serve?

Madeline – I think it was just the holding on to it. It fit perfectly in my hand. and I could have it with me whenever I needed it. I needed it the most at night – I’d find it tight in my fist when I woke up. This was something Paul had never seen or touched so it was surprising it meant and still means so much to me.
The other things I treasure are photos of him, mementos that he left behind (books, records, CDs, Olympic pins, little things he kept in his room), things that remind me of him (my Buddha collection, jazz music, musicians he liked). And of course the biggest tangible grounding tool is my office. I converted his bedroom (the last room he lived in before his death) into my office.

Being there makes me feel like he’s always there with me.

Thank you, Laura Dennis. I look forward to your guest post here on Monday, July 1.

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