World Bipolar Day: the Birthdate of Vincent Van Gogh

After over a decade of – granted, very rocky – general stability, I suffered a mental health episode in my late 30s that both came as quite a shock to me and pretty much knocked me out of the playing field for quite some time.

I had to cause recently to list a number of the things that were different about myself – about my very essence – after that episode, than before.

They were pretty essential. They included things like, although I was a voracious reader, ever since the time I could read, and used reading as a form of escape and comfort, and was a literature major in college, writing a 100+ page thesis on a contemporary poet, today I can hardly sit and concentrate to read a book at all. My doctor has me on a regimen of 15 minutes a day–which I split up (I never asked if that was alright), into 3 sections, each of which pretty much involves reviewing the last.

My sense of time was fundamentally altered. I went from feeling a constant pressure that I didn’t have enough time, a pressure so intense I even felt it in my chest, to a feeling that time had expanded on me, like a hot air balloon, and that I would be unable to fill the minutes. That song from Rent plagued me–you remember the one.  The one that starts off, “Five hundred twenty five thousand six hundred minutes. . .”? That’s what each day felt like. No–each hour.

And then there was the matter of my intelligence. I actually – and I know you have to take this on faith – was once quite smart. And there are some people who say – you would know them if you met them, as their last names are Finkel –that my intelligence remains.

But sickness and treatments can take their toll, and a recent IQ test showed a number I wouldn’t care to share here.

All that is fascinating background to the following relevant change: I was compulsively early my whole life. I would get to class, say, 20 minutes before it started, and just twiddling my thumbs in the car. But, like I say, times of changed. today I find myself running around the house, usually with my water bottle with its top off spilling haphazardly, one shoe on come out one shoe in hand, my meds in my mouth, dissolving unpleasantly while I somehow don’t use the water bottle–& ways, always I am looking for the keys, is the time for a class or an appointment draws perilously close.

So last year I missed it completely.

So I am here to inform you that today is the second world bipolar day.

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Bipolar people, on average, suffer 10 years before receiving treatment231

Major Depression is the #1 reason for disability worldwide 235
Bipolar disorder increases suicide risk by 15X more than that of the general population 230
Less than 50% of bipolar disorder patients take their medications 236
Antidepressants are prescribed second only to analgesics (painkillers)54
15% of bipolar persons may not experience the usual clinical depression that accompanies bipolar disorder 232
Bipolar disorder is the 4th-highest reason for SSA disability awards62

That bipolar disorder is the sixth leading cause of disability in the world (WHO)?

That only 1 in 4 bipolar sufferers receives an accurate diagnosis in less than 3 years?

That all of the following people were thought to now have or to have suffered from bipolar disorder in their lives: Agatha Christie, Drew Carey, Edgar Allen Poe, Isaac Newton, Jim Carey, Larry Flynt, and Winston Churchill?

And of course, Vincent Van Gogh.

It’s good to be in such worthy company.

 

March Gambling Madness–The Addict and the Co-Dependent

More money is wagered on March Madness than on the Superbowl–an expected $9 billion this year.  Perhaps that’s why March is Problem Gambling  Awareness Month.

Betting on March Madness, or other office pools throughout the year, is socially acceptable.  More than that; it’s cool, trendy, and sociable. And that’s true even though the “professional gamblers” are, as always, out there to take advantage.  The family or friends with close involvement to the gambler–often referred to as the co-dependent–dreads the highly publicized March event.

For problem gambler and their families,  March Madness exhibits the painful rather than the “cute” sense of “madness”. Pathological gamblers hide the secret of their destructive urges, lying about losses, while boasting about big gains, which simply stoke the compulsion to “go again” as soon as possible. Preoccupied with past gambling adventures, or planning the next one, they can’t concentrate on work, friends, family, or chores.  They  destroy close relationships, manipulating spouses, family, and friends to obtain money. They beggar their relatives, wiping our credit cards and may turn to stealing to feel their habit.

Pathological gambling is defined by persistent and recurrent patterns of maladaptive gambling behavior, resulting in impaired functioning, poor quality of life, and high rates of bankruptcy, divorce, and imprisonment.  Suicide attempts are common, reported in 17% of people in treatment for pathological gambling (Petry and Kiluk, 2002).  And that doesn’t count lesser forms of self-injury, such as banging one’s head or fist against the wall.).

Depressed or anxious people may experience gambling as significant symptom relief, viewing the risk of financial distress or criminal activity (stealing, embezzling, writing bad checks) as a comparatively minor setback.  When the gambler attempts to cease or limit his impulsive behavior, he or she may become irritable and distracted. If someone close to him or her tries to set limits, the blaming, anger, and deceit increase.

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A indicator of the addictive nature of the compulsion is that huge losses  increase gambling activity.  Rather than teach the gambler an avoidance lesson, the loss urges the addictive person to make bigger bets to “get back to even.”  Perhaps losing is in a strange way satisfying, because the guilty gambler feels he deserves the punishment. Compulsive gamblers who lose large sums at the beginning of a gambling session often imagine that the entire loss could be recouped with a single large win at any moment. Their distorted thinking assures them that statistics are in their favor; if they’ve lost 10 times, they mistakenly believe the odds favor the next round.

Pathological gamblers may have abnormal reactions to stress.  A 2004 study by Brown, et al., found that such individuals were depressed (“negative pre-gambling valance”) before gambling. The kicker is that their mood significantly decreased if they lost but did not significant improve if they won. In other words, they lose emotionally even those few times that they win the money.

An additional ingredient in the pathological strew is impulsivity.  Impulsive individuals tend to be highly response to positive reinforcement (winning) but rather insensitive to punishment (losing). They have difficulty imagining negative outcomes. They also seem unable to divide their attention among competing stimuli, and therefore may be unaware of internal warning of restraint and danger (Adams and Kushner, 2004)

Individuals with addictions tend to share two common features: 1) being chronically under- or over-aroused, and 2) having experienced childhoods that led to feelings of inadequacy, rejection or guilt (Grant and Kim , 2002).  Perhaps these 2 features keep the the co-dependent (responsible spouse, relative, child, friend) more committed. The co-dependent feels needed, feels sorry for the gambler, hoping to compensation for the painful childhood by giving unconditional love.

The sad truth is that  you can never be in a healthy relationship with a pathological gambler.  The most important “relationship” in the addict’s life is with gambling.

When the co-dependent strategy fails, the co-dependent feels like a victim, becoming angry and resentful.   This individual is the fixer, the enabler, the excuser, the one who picks up the pieces of the gambler’s chaos, the one feels he or she owns the problem.  He or she lies for the gambler, pays the debts, makes up for the losses, and denies the evidence. The co-dependent believes the excuses, forgives, sets up new limits, which are inevitably broken. The tearful reconciliation scenes provide temporary respite, although both the addict and the co-dependent know deep inside that they only finished the more recent round of blame, guilt, and tearful promises to do better.

Why doesn’t the co-dependent leave before the money is gone and the stealing has gotten dangerous? Some of the same reasons the gambler stays stuck. Low self-esteem, self-blame, victim mentality, and often a family history of alcholism or other impulsive behaviors.  In a couple relationship, fear of being alone.  When the addict is a child or sibling, fear that the gambler will become depressed, publicly shamed, divorced, fired, imprisoned, or suicidal. And over-riding them all, fear of accepting the reality–that the person you love is in a diasatrous downward spiral that only he or she can control. Admitting you have no control over that outcome is the scary first step.

Because pathological gambling involves illegal or immoral behaviors, shame and secrecy often prevent or delay treatment.  The gambler may not be aware that he or she is struggling with a known disorder which has treatment options. Those options include group programs for impulse control and medications used for opioid addictions. Talking treatments seem to help initially, as the patient experiences relief from the secrecy, but impulsive patients often do not follow through on recommendations. Anti-depressants and 12-step programs haven’t demonstrated significant benefits.

The co-dependent, however, can benefit significantly from both individual and group coaching, including 12-step co-dependency meetings.  The co-dependent can change his or her life by accepting, setting boundaries, detaching, realistically evaluating what s/he can or cannot control, and making new choices.

One thing that surely doesn’t work is trying to control someone else’s pathological gambling.  While it’s critical to find out if someone you love is lying about his or her whereabouts and taking money out of bank accounts, credit cards, or even your personal stash, you won’t be able to stop the addict by cutting up the credit card, closing the bank account, or checking his or her pockets for receipts.  A compulsive gambler will find another source.  Confrontations, guilty admissions, and promises to reform are part of the pathological pattern. You need support to avoid getting sucked in. Take a look at some warning signs in my  series of blog pieces, “Getting taken to the Cleaners, the Poorhouse, or Worse–To Jail.”

Divorce will prevent future gambling debts from devastating your credit, but, sadly, it won’t release you from the debts racked up during the marriage. Debts are joint marital obligations, and the gambler isn’t going to have the goods when the creditors come knocking.

If you suspect or know you’re involved with a pathological gambler, this is a good month to ask yourself why you’re looking the other way.  It’s time to get some coaching help. You can’t tell anyone else what to do, but you sure can decide what actions you yourself are willing to take.

Eating Disorders–What’s In Your Mind?

Eating disorders come in a bunch of new flavors these days.  The DSM V (the newest version of the diagnosis and classification of mental disorders) offers an expanded menu, compared to our earlier choices of anorexia, bulemia, binge eating disorder, or the old DSM IV option, NOS (Not Otherwise Specified).  The following diagnoses will surprised some of you but maybe comforting to those who could use a name for their troubling symptoms.

Pica refers to the compulsive eating of nonfood substances.  The astonishing list includes dirt, soap, glue, paint, ice, toothpaste, hair, coffee grounds, and even cigarette butts and ashes. Yes, eating those things.

Patients with rumination disorder regurgitate their food, which they then either re-chew, re-swallow, or spit out.

Avoidant/restrictive food intake disorder manifests in one of three ways: apparent lack of interest in eating or food; avoidance based on the appearance, taste, smell, or texture of food; or concern about negative consequences of eating, such as choking or nausea.

NOS in the DSM V  is now known as “Other Specified Feeding or Eating Disorders.” There are 5 subtypes in this category:

Atpical anorexia nervosa, in which the patient has the symptoms of the disorder but, even with weight loss, remains within the normal weight range.

Those with bulemia nervosa (of low frequency and/or frequent duration)  meet the criteria for bulimia, but those behaviors occur less than once a week or for less than 3 months.

Ditto for binge eating disorder (of low frequency, etc).

Purging disorder refers to purging (vomiting, laxatives, diuretics) without binge eating.

And bringing up the rear is a disorder so many people complain about without realizing they’ve “got something”: night eating syndrome.  This syndrome is the name for excessive food consumption after dinner or eating at night after awakening from sleep.

So there’s the facts. Now I ask myself, as a coach experienced in helping clients with eating disorders: what do I know, and how can I help.

I’ve learned that eating disorders are a torment of the mind.  Looking at a client’s weight tells you very little about her thoughts.  A man or woman whose weight is within normal limits can still be driven to distraction by an internal critical  voice.  “You’re disgusting. Look how much you ate.”  “Why can’t you control yourself, Miss Lardbucket?”  “Your thighs/tummy/rear end are fat.”  “Look at your midriff bulge!” “Everyone in this room is thinner than you.”  “Everyone is fatter than you.”

The voice gives lessons and rules: “First work out on the treadmill and record how many calories you burned.  That’s the amount you’re allowed to eat today.” “Because you ate carbs today, tomorrow you’re allowed to eat only salad.” “You had a piece of pizza. You’ll increase your bike riding form 2 hours to 3 to make up for it.” “Don’t eat anything with more than 0 grams of fat.”” Be a vegetarian, don’t eat anything with gluten.” “Sugar? Addictive; once you start, you’ll eat the whole pie.”

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The voice  also offers comparisons:  “You ate more than anyone else today. Tomorrow, only water and plain yogurt.”  Or the “good news”:  “You’re the only only at the party who ate so little. Only 2 carrots. I’m proud of you.”

And the voice prevents you from hearing the words and feeling the needs of others around you.  You have no energy for relationships. Your main “relationship is between you and the voice.

The voices alienates friends, family, and colleagues. “I wish I could join you for a drink after work, but I’m so busy.”  Perhaps your friends are fooled when, for the 5th time you’re at a restaurant together, you announce you’re not ordering anything because you’ve just eaten. Maybe they don’t notice that you mash your serving of birthday cake around your plate so they’ll think you’re enjoying your party. The intense mental concentration required to avoid eating the cake–but make it look as if you did– brings you to a different space from others in the group–a lonely, painful space.

How do you recover, how do you shush that voice for good?  Begin by recognizing that voice isn’t you. I know it seems like you because it’s in your head.  But there’s much bigger, healthier you that knows how to take care of yourself and get well.  Read Jenni Schaefer’s Life Without Ed.”  Ed is what Jenni named her voice.  She offers clear advice on identifying the voice, separating from it, and gaining control. She recommends putting together a healing team of professionals to help in the journey.

If you’re ready to getting started on your healing journey, begin by interviewing the professionals you’re going to work with.  Avoid treaters who set rules for you.  Since eating disorders have so much to do with control, your inner critic is likely to sabotage people who tell you what to weigh, when to exercise, what to eat, how much, and when. Look for professionals who understand the bigger picture, the mental torment of the inner voice.

Today begins  National Eating Disorders Awareness Week.  A good week to get started.

 

 

 

Children acting out parental struggles

Charlotte was an energetic, exciting, and dominant woman who loved variety.   She chose Charlie, her opposite, as a spouse.  Charlie ate the same menu almost every day:  two eggs for breakfast, chicken salad for lunch, pasta for dinner.  This lack of imagination drove Charlotte nuts.  She craved new adventures, new food–never the same thing twice.

Charlotte loved to travel.  Planning the trip was a thrill in itself.  She cleverly arranged each leg of the journey to maximize the locale’s greatest hits and, naturally, its best restaurants.  If fried crickets were just the thing in Japan, Charlotte would seek them out for the first night of the trip.  Charlie would have to negotiate long and hard for the occasional stay-in room service meal, which he ate in  exhaustion from the day’s museum mastery.

When their two sons–Corey and Chris–began to mature,  it seems the parents had produced one of each–one adventure-seeker, one routine-lover. Now, you might think this set-up would be great: one kid for each parent.  However, the parents yearned for the idealized family, where all four members shared experiences together.  And there was no one to break a tie on any activity.

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So, the one who cared the most fought the hardest and got his or her own way.  Corey figured this out quite young, and, with Charlotte as his double, became the junior activities director. When Corey was old enough, he took over trip planning, mocking his younger brother’s lack of interest.  “What could possibly be wrong with a trip to Morocco?  What else you have to do?”

Dad was sympathetic with Chris, who expressed his own viewpoint, but neither fellow wanted to provoke the anger of the Mom-Corey team.  Chris just went along with every vacation, although his lack of enthusiasm provoked Corey .  As time went on,  Chris grew old enough to stay home alone and offered to do that during holiday time.  Dad was happy to make it a two-some.  But Mom said that wasn’t a family, so Chris suffered along, not always in silence.

Chris shut down more and more; he was depressed.  His brother’s mocking of his friends and his hobbies ruined his pleasure, so he gave up most of his interests.  At least Dad understood, because he had done the same in order to find the energy for Mom’s intense and busy life.  Dad let Chris know he was on his side, but urged him not to provoke an argument with Corey.  “Just don’t fight with him. That’s all I ask,” was Dad’s request.

It’s clear in the story that Chris got a raw deal.  What may not be as obvious is the harm to Corey,  as well as Mom and Dad,  resulting from this family pattern. In family systems terminology, Chris became the Identified Patient.  The IP unconsciously agrees to manifest the problem that is actually a stuck family system.

Charlie became less and less spontaneous as Charlotte continued to make the family’s decisions. Charlotte forgot to trust the wisdom of her spouse, becoming frustrated and fatigued by the effort to run everything her own way. She complained that she always had to pick the movie, the place to eat afterwards, even the parking lot. Charlie argued back that she cared more than he did, and she overrode him anyway.

Corey missed out on learning one of life’s most precious lessons: let’s make a deal. That lost affected his relationships for many years to come.  He was used to others’ giving in to him, and used to telling others how to enjoy their lives. He was quick to mock the choices of others, and some people avoided him.  Girlfriends, initially attracted to his energy and dynamism, left for someone who could better accommodate their wishes.

The good news for a family like this–or one stuck in any pattern with rigid roles–is that a change in any one of the family members benefits the entire system.  Chris sought help from a family systems expert. He learned that Corey, like himself, was acting out a pattern that was not of his own making.  Corey became, in Chris’ eyes, just his brother, not the family “winner.” The power imbalance shifted for the boys, so Mom and Dad were less involved in their arguments.

If the family benefited from just one member’s positive changes, imagine the growth if all four were to seek the advice of a family therapist, either together, separately, or in pairs.  Change is hard, but, boy, is it worth it.