Tuesday, May 13, 2014

Multimedia Portrait of My Bipolar (Pt. 1)


Beware of Bertha Claire (then, age 2.5)
*Excerpt from my mom's 1991 Christmas letter

Video Introduction
Mercurial Teenage Me
*Sixth Grade English Assignment
video


My Diagnosis: Bipolar II Disorder (with mixed features & rapid cycling)
Approximate Age of Onset: 23
Primary Stressors: tumultuous relationshipmiscarriage & first semester of grad school (i.e., choosing to do my thesis on "The Rhetoric of Childhood Sexual Trauma" -- having lived my topic for 17 years) 
Pyschotherapy: Dialectical-Behavioral (sort of)
Mood Stabilizer: lithium carbonate
Co-morbid Disorders: ADHDOCD, PTSD
*For a quick, easy overview of bipolar, check out
this infographic -- made available by HealthResearchFunding.org


Myers-Briggs Personality Type: INFJ 
My INFJ hero?
"Named must your fear be
before banish it you can."
- Master Yoda
INFJ Overview



Bipolar Mood States: What are they, 
and how are they different from non-affected moods?

iMoodJournal App for
Tracking Bipolar Mood
The four broad mood states (or episodes) are: mania (bipolar I), hypomania (bipolar II), mid-level, and major depression. Although hypomania is often referred to as a "mild" version of mania, their general criteria in the DSM are nearly identical -- with the few critical distinctions being duration of symptoms, degree of social/occupational impairment (e.g., job loss due to psychosis), and the risk of hospitalization. 

In addition, mood states may have "mixed features" (e.g., if manic/hypomanic, the "mixed" specifier would be appropriate if at least three symptoms of a depressive state are reported as well). 

Finally, a person is said to be "rapid cycling" if he or she experiences at least four distinct mood disturbances in 12 months. 

How are bipolar moods different?

Meteorological Mirror
*Facebook status

This is an excellent question – and one I should probably let the neuro/psych experts answer – but I will say that a crucial variation (to my knowledge) hinges upon an element of bipolar often glossed over in even the best textbooks – i.e., that it’s as much a disorder of cognition and energy as it is of mood. 





iMoodJournal Mood Scale
& General, Weekly, Daily, & Physical
Mood Trends
Thus, dramatic ups and downs profoundly interfere with:
- executive functioning (e.g., attention span, working memory, task and time management, impulse control, etc.)
- sensory intake and integration
- psychosocial stability (e.g., getting and holding down a job; maintaining complex interpersonal relationships with friends, family, and/or romantic partner[s])
- the capacity to attend to one’s own physical, emotional, and psychological health (e.g., getting enough sleep, eating well, taking medications, making informed and responsible decisions, etc.)

Whereas non-affected moods are more transient, relatively easier to regulate, and less extreme, bipolar moods – even when treated with the appropriate combination of meds and therapy – are by their very nature excessive, volatile, difficult to regulate (more so, to resolve) on one’s own, and can fluctuate between two opposite ends of a spectrum in a matter of minutes/hours, occur simultaneously, or drag out episodically for anywhere from days to weeks to months.  



My UPs! 


Photos and corresponding mood ratings 
Hypomania: a period of abnormally and persistently elevated mood. While euphoria is the stereotypical expectation, a person may instead be predominately irritable (dysphoric), or alternate back and forth between the two.

Excerpt from iMoodJournal Entry
Mid-Hypomanic Episode
Mood: 9











    For an episode to be deemed hypomanic, at least three of the following must be present every day for four or more consecutive days (one week for manic):
    1. Inflated self-esteem or grandiosity (ranges from uncritical self-confidence to hypersexuality to a delusional sense of expertise).  
    2. Decreased need for sleep (e.g., may go days with little to no rest without feeling tired).
    3. Intensified speech (e.g., pressured, loud, rapid, and difficult to interrupt; focused on sounds [rhyming, punning], theatrics, and self-amusement).
    4. Racing thoughts (e.g., flight from one idea to the next faster than can be processed or articulated).
    5. Distractibility (e.g., inability to multitask or filter out irrelevant/unimportant external stimuli).
    6. Increase in goal-directed activity (e.g., excessively planning and/or pursuing a goal -- often social, occupational, academic, or sexual) or psychomotor agitation (e.g., pacing, inability to sit still, messing with clothing, hair, or skin).
    7. Excessive and impulsive involvement in pleasurable, high-risk activities (e.g., shopping sprees, gambling, reckless driving, substance abuse, indiscriminate/inappropriate sexual behavior) with often devastating consequences.
    Multimedia Examples of Hypomania


    Bipolar Mom, Epileptic Pup
    *iMoodJournal Entry

    *Notes: In the interest of representing mood states as faithfully as possible, movement in all dance videos is improvised (made up on the spot), rather than choreographed ahead of time; as such, the clips may seem similar. Just as patterns of distinct words and phrases appear in speech and writing, certain steps and combinations do so, too, in dance.


    Also -- although I'm sure a compelling case could be made for the dualistic symbolism of the barstools (or their resemblance in function to stripper poles, I'm told), I rely on them largely as supportive props (like a ballet barre) and focal points; among the myriad side effects of lithium are a few that compromise balance and spatial awareness (e.g., dehydration, dizzy spells, poor depth perception, and tremors). 


    Some videos may not play on smart phones and other mobile devices. 



    a) Dancing while up (euphoric)

    Dates: Multiple (within the last 2 months)
    Moods: all high 8
    Hypomanic Features:
    - inflated self-esteem (#facepalm)
    - racing thoughts (e.g., around the :15 second mark, I'm falling behind the music -- brain's moving more directions than body can go at once; again at :41)
    - distractibility (e.g., smiling "out of character" & losing momentum whenever I hear Ava sigh/snore from her chair)
    psychomotor agitation (e.g., hair whiplash, hands clenched into fists [unusual, given my ballet training]; clinging to my shirt; or touching inner arms [what we call "self-soothing" in DBT] -- all three of which suggest overstimulation and mounting anxiety)

    video

    b) Talking while up (euphoric)
    Dates: Multiple (Fall, 2013)
    Moods: high7/low8                               
     Hypomanic Features: Yeesh, all of them... except high-risk behavior. 

    In addition, note the word conjugation and retrieval issue around 1:26. As a writer, this problem is among the only aspects of bipolar to make me feel, at times, legitimately insane. 


    video



    c) Writing while up (euphoric)

    Date: 14 January 2014
    Mood: low 8
    Context: The following is one of at least five drafts I wrote in memory of a longtime friend and former co-worker upon hearing news of his suicide. As is evident, humor is among the more inappropriate coping skills I picked up as a child in order to distract myself - and others - from emotions too overwhelming to confront (e.g., grief, vulnerability, rejection, etc.).
    Hypomanic features: sound devices, pressured rhythm/cadence, parallelism/repetition, antitheses, abstraction, & imagery.

    I remember well the morning I met David Coover…

    It was day one of week one – my very first session of Camp Rising Sun in the summer of 2004, I believe – and I was a new Camper in Leadership Training (CILT) with just enough sense to be nervous. And early.  


    Under normal circumstances, my nerves could’ve passed for over-enthusiasm, but alas, the shade of yellow cotton designated for CILTs was prone to such broadcasts as, “LOOK HOW MUCH I’M SWEATING!” at unsuspecting passersby.


    Abetted by Irish blood summoned too easily to the surface, this t-shirt – with all the discretion of a rubber duck in bath water just drawn – left me no choice but to bounce about the noisome chlorinated air, learning to wear my heart across my back and around the collar and in cheeks the shade of love before it knew better.

    Through swinging lobby doors probably meant to be pulled, I pushed my way into the only place I’ve never felt small. From the almost empty room – scented chlorine and sweaty socks, with a hint of … chocolate syrup? – I realized I was early by more than just a little.  

    Sandpaper sounds of busywork drifted from within the walls surrounding a front desk, where the office manager appeared to be nesting – neon post-its strewn about her like feathers. In words that smiled for themselves, her breezy “Sit tight, hun!” was warm and not a request.

    Tasked with the disentanglement of book-bag from antsy limbs, I fumbled around the room for patience I hadn’t thought to pack. Instead, I found Coover – an almost vibrating vision of round, freckled cheeks and would-be-curls cut short – who had perched himself a gentlemanly distance of one and a half chairs to my right.

    As I soon learned he was apt to do, Coover passed the time by humming and drumming the same few measures of a song I was positive didn’t exist, while I resumed the inexhaustible preening of 15 with an assist from a compact mirror.

    Coover’s clumsily brilliant conversation starter? “You won’t need that here…” I disengaged from the staring contest I probably wouldn’t have won against my reflection.

    “Pardon?” I chirped (as he learned I was apt to do).

    Although I can’t quite recall his reply in its entirety, I’ll not soon forget the ensuing pecks of an index finger against the mirror. Which erupted in an awkward bout of tug-of-war. Which I lost to my kitten-curious new adversary upon one swift yet somehow still gentlemanly, punch to the shoulder – packed with just enough jest that the pain tickled instead of hurt.

    More appropriate version written in low 6 (mid-level)
    And I laughed. And laughed. And laughed until I had no choice but to surrender to a nearly incapacitating siege of hiccups. Despite the oxygen-deprived sensation that my scalp had fallen asleep, the clarity of that moment remains unrivaled: I knew that as long as I was there, I was part of something. I knew I was home.  





    d) Dancing while up (dysphoric)
    Dates: Multiple (within last 2 months)
    Moods: all high 7
    Hypomanic Features: primarily psychomotor agitation and irritability

    video







    "Coming Out"/ I'm Sorry
    *Letter sent three days later
    Bertha Claire's Back to Play
    *Text Message
    Mid-March, 2013
    e) Writing while up (dysphoric)

    “I had a terrible temper, after all, and though it rarely erupted, when it did it frightened me and anyone near its epicenter. It was the only crack, but a disturbing one, in the otherwise vacuum-sealed casing of my behavior.” 

    -Kay Redfield Jamison, An Unquiet Mind: A Memoir of Moods and Madness





    back down... 
    iMoodJournal Photos & Mood Ratings
    Major depressive episode: includes at least 5 of the following symptoms occurring over the same 2-week period.



    1. Depressed mood most of the day, nearly every day, as reported by self or others.
    2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
    3. Significant weight loss or gain/decrease or increase in appetite nearly every day.
    4. Insomnia or hypersomnia nearly every day (i.e., difficulty/delay in falling asleep, or sleeping excessively).
    5. Psychomotor agitation or retardation (e.g., slowed thinking, speech or body movement) nearly every day -- often observable by others.
    6. Fatigue or loss of energy nearly every day.
    7. Feelings of worthlessness or excessive, inappropriate, or delusional guilt nearly every day.
    8. Diminished ability to think or concentrate nearly every day.
    9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. 
    *Note: those with bipolar II tend to spend approximately 75% of their time (on average) in depressive states,  putting them ... us ... at significantly higher risk for suicide than those with bipolar I. 


    a) Dancing while down (mild)


    Date: 10 March 2014                                                             
    Mood: low 4                                          
    Depressive Features: Though some may not be evident, all but # 3

    video


    b) Writing while down (mild)


    iMoodJournal Entries






    Stay tuned for Part 2: Mixed States, Rapid Cycling, & Dissociative Episodes!

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