What are Positive and Negative Symptoms of mental illness? Positive symptoms are behaviors and beliefs that the person with mental illness has that should not be there. Negative symptoms are capabilities and skills that the person with mental illness should have, but they are missing or considered deficits.
For example, Positive symptoms of schizophrenia can include: feelings of being controlled by outside forces, hearing, seeing, smelling or feeling things which are not there, (hallucinations) and unusual beliefs, (delusions).
Negative symptoms of schizophrenia can include: Loss of normal behaviors such as tiredness, loss of concentration and lack of energy and motivation; inability to hold a job, and reduced expression and emotions.
More Positive symptoms can include: Disorganized thinking, apparent in patients' speech patterns as schizophrenia progresses. Affected people lose their train of thought during conversations, make loose associations of topics (tangentially jumping from one topic to another apparently at random, or on the barest of associations), and give answers to unrelated questions. Disorganized behavior may range from simple problems sustaining goal-directed self-care behaviors such as personal hygiene to unpredictable and bizarre socially inappropriate outbursts. For example, people may not dress according to the weather.
Examples of Negative symptoms are detailed below. "Affect" refers to emotional expression. Affective flattening, distinguished by a restricted range of expressed emotions, is a fairly common negative symptom among some schizophrenia patients. Patients with affective flattening show relatively immobile and unresponsive facial expressions, often accompanied by poor eye contact and little body language or movement. "Avolition" describes a loss of motivation; the will or desire to participate in activities or to do things. Some patients with schizophrenia show avolition in that they will sit still for long periods of time, seemingly indifferent to their surroundings, and without displaying any interest in work or social activities. In extreme cases, this behavior becomes catatonia.
Disorganized symptoms include thought disorder, confusion, disorientation, and memory problems. Fortunately "New Generation Medicines" (NGM-future topic) can help greatly with positive, negative, and disorganized symptoms. Many times NGMs take away all the positive symptoms. If not they are typically markedly diminished. Geodon and Clozapine are two medicines that we have seen take away delusions and hallucinations, and also restore negative symptom deficits to the extent that productive work was restored. And we were pleasantly surprised at our son's new found awareness. For example he often said, "How could I have done that?" as he looked back on past behavior and thinking. Treatment today offers much hope, even in the face of both Positive and Negative symptoms.
Tuesday, November 11, 2008
Thursday, October 23, 2008
Guest Writer
The following article was written by John Hoelzel, NAMI President of Grayson, Fanin and Cooke counties and is published with his permission.
Mental Health and You -What is a Nervous Breakdown?
Mental Health and You -What is a Nervous Breakdown?
What is a Nervous Breakdown? A "Nervous Breakdown" is a popular term, not a clinical term, having nothing to do with nerves, that was originally used to describe a mental disorder that a person experiences. It exists largely due to the stigma of mental illness (to be covered later in another mini-series) since some people preferred to have a physical (Nerves) illness as opposed to a psychiatric illness. It generally describes an experience like "snapping" under immense pressure, mental collapse or mental and physical exhaustion. This vague term can be used to hide a diagnosis; to avoid the stigma of a diagnosis; and also when the reasons for certain loss of functions are unknown or denied. There are many disorders that can fit within the criteria of "Nervous Breakdown", but modern psychiatry breaks the term "nervous breakdown" into more precise mental illness diagnoses (analogous to specific cancer diagnoses), covered in our next article. The specific disorder that mimics a vague "Nervous Breakdown" most closely is Major Depressive Disorder (Clinical Depression).
Very generally a "nervous breakdown" can be the acute manifestation of a specific mental illness and as such can sometimes lead to considerations of suicide, or attempts at self-harm. The sufferer can experience what they feel as the total breakdown of ability to deal with even the most minimal stresses of day-to-day living, and in extreme cases can become entirely non-functional and withdrawn.
Causes or triggers of "breakdowns" can include our prior topics on chronic and unresolved grief, including loss of job, academic or job stress, serious or chronic illness in a family member, divorce, death of a family member, and other traumatic life changes. Whatever the cause, the sufferer typically becomes aware of their limits and tolerance to stress.
Surveys show that about one-third of Americans feel on the verge of a nervous breakdown at some point. Studies estimate that 50-million Americans suffer some form of mental illness in their lifetime. Mental Illness treatment (a future article in this series) can include medication and counseling such as Cognitive Behavior Therapy. Peer group participation and "expecting recovery" (future topics) also provide remarkable hope for improvements in meeting life goals and restoration of more normal functioning.
Thursday, October 2, 2008
A Reminder to Us All - From the WOW Newsletter
A message for all women
THIS IS MOVING. HOW QUICKLY WE FORGET.....IF ....WE EVER KNEW......WHY WOMEN SHOULD VOTE
This is the story of our Grandmothers and Great-grandmothers; they lived only 90 years ago.
Remember, it was not until 1920 that women were granted the right to go to the polls and vote.
The women were innocent and defenseless, but they were jailed nonetheless for picketing the White House, carrying signs asking for the vote.
And by the end of the night, they were barely alive. Forty prison guards, wielding clubs and with their warden's blessing, went on a rampage against the 33 women wrongly convicted of 'obstructing sidewalk traffic.' They beat Lucy Burns, chained her hands to the cell bars above her head and left her hanging for the night, bleeding and gasping for air.
They hurled Dora Lewis into a dark cell, smashed her head against an iron bed and knocked her out cold. Her cellmate, Alice Cosu, thought Lewis was dead and suffered a heart attack.
Additional affidavits describe the guards grabbing, dragging, beating, choking, slamming, pinching, twisting and kicking the women. Thus unfolded the 'Night of Terror' on Nov. 15, 1917, when the warden at the Occoquan Workhouse in Virginia ordered his guards to teach a lesson to the suffragists imprisoned there because
they dared to picket Woodrow Wilson's White House for the right to vote.
For weeks, the women's only water came from an open pail. Their food--all of it colorless slop--was infested with worms.
When one of the leaders, Alice Paul, embarked on a hunger strike, they tied her to a chair, forced a tube down her throat and poured liquid into her until she vomited. She was tortured like this for weeks, until word was smuggled out to the press.
http://memory.loc.gov/ammem/collections/suffrage/nwp/prisoners.pdf
So, refresh my memory. Some women won't vote this year because - why, exactly? We have carpool duties? We have to get to work? Our vote doesn't matter? It's raining?
Last week, I went to a sparsely attended screening of HBO's new movie 'Iron Jawed Angels.' It is a graphic depiction of the battle these women waged so that I could pull the curtain at the polling booth and have my say. I am ashamed to say I needed the reminder.
All these years later, voter registration is still my passion. But the actual act of voting had become less personal for me, more rote. Frankly, voting often felt more like an obligation than a privilege. Sometimes it was inconvenient.
My friend Wendy, who is my age and studied women's history, saw the HBO movie, too. When she stopped by my desk to talk about it, she looked angry. She was--with herself.
'One thought kept coming back to me as I watched that movie,' she said.
'What would those women think of the way I use, or don't use, my right to vote? All of us take it for granted now, not just younger women, but those of us who did seek to learn.'
The right to vote, she said, had become valuable to her 'all over again.'
HBO released the movie on video and DVD. I wish all history, social studies and government teachers would include the movie in their curriculum. I want it shown on Bunco night, too, and anywhere else women gather. I realize this isn't our usual idea of socializing, but we are not voting in the numbers that we should be, and I think a little shock therapy is in order.
It is jarring to watch Woodrow Wilson and his cronies try to persuade a psychiatrist to declare Alice Paul insane so that she could be permanently institutionalized. And it is inspiring to watch the doctor refuse. Alice Paul was strong, he said, and brave. That didn't make her crazy.
The doctor admonished the men: 'Courage in women is often mistaken for insanity.'
Please, if you are so inclined, pass this on to all the women you know.
We need to get out and vote and use this right that was fought so hard for by these very courageous women. Whether you vote democratic, republican or independent party - remember to vote.
History is being made
THIS IS MOVING. HOW QUICKLY WE FORGET.....IF ....WE EVER KNEW......WHY WOMEN SHOULD VOTE
This is the story of our Grandmothers and Great-grandmothers; they lived only 90 years ago.
Remember, it was not until 1920 that women were granted the right to go to the polls and vote.
The women were innocent and defenseless, but they were jailed nonetheless for picketing the White House, carrying signs asking for the vote.
And by the end of the night, they were barely alive. Forty prison guards, wielding clubs and with their warden's blessing, went on a rampage against the 33 women wrongly convicted of 'obstructing sidewalk traffic.' They beat Lucy Burns, chained her hands to the cell bars above her head and left her hanging for the night, bleeding and gasping for air.
They hurled Dora Lewis into a dark cell, smashed her head against an iron bed and knocked her out cold. Her cellmate, Alice Cosu, thought Lewis was dead and suffered a heart attack.
Additional affidavits describe the guards grabbing, dragging, beating, choking, slamming, pinching, twisting and kicking the women. Thus unfolded the 'Night of Terror' on Nov. 15, 1917, when the warden at the Occoquan Workhouse in Virginia ordered his guards to teach a lesson to the suffragists imprisoned there because
they dared to picket Woodrow Wilson's White House for the right to vote.
For weeks, the women's only water came from an open pail. Their food--all of it colorless slop--was infested with worms.
When one of the leaders, Alice Paul, embarked on a hunger strike, they tied her to a chair, forced a tube down her throat and poured liquid into her until she vomited. She was tortured like this for weeks, until word was smuggled out to the press.
http://memory.loc.gov/ammem/collections/suffrage/nwp/prisoners.pdf
So, refresh my memory. Some women won't vote this year because - why, exactly? We have carpool duties? We have to get to work? Our vote doesn't matter? It's raining?
Last week, I went to a sparsely attended screening of HBO's new movie 'Iron Jawed Angels.' It is a graphic depiction of the battle these women waged so that I could pull the curtain at the polling booth and have my say. I am ashamed to say I needed the reminder.
All these years later, voter registration is still my passion. But the actual act of voting had become less personal for me, more rote. Frankly, voting often felt more like an obligation than a privilege. Sometimes it was inconvenient.
My friend Wendy, who is my age and studied women's history, saw the HBO movie, too. When she stopped by my desk to talk about it, she looked angry. She was--with herself.
'One thought kept coming back to me as I watched that movie,' she said.
'What would those women think of the way I use, or don't use, my right to vote? All of us take it for granted now, not just younger women, but those of us who did seek to learn.'
The right to vote, she said, had become valuable to her 'all over again.'
HBO released the movie on video and DVD. I wish all history, social studies and government teachers would include the movie in their curriculum. I want it shown on Bunco night, too, and anywhere else women gather. I realize this isn't our usual idea of socializing, but we are not voting in the numbers that we should be, and I think a little shock therapy is in order.
It is jarring to watch Woodrow Wilson and his cronies try to persuade a psychiatrist to declare Alice Paul insane so that she could be permanently institutionalized. And it is inspiring to watch the doctor refuse. Alice Paul was strong, he said, and brave. That didn't make her crazy.
The doctor admonished the men: 'Courage in women is often mistaken for insanity.'
Please, if you are so inclined, pass this on to all the women you know.
We need to get out and vote and use this right that was fought so hard for by these very courageous women. Whether you vote democratic, republican or independent party - remember to vote.
History is being made
Wednesday, September 24, 2008
Untitled
I am in a crisis mode personally, involving my daughter, Caiti. At this point, it appears we are losing, not just the battle, but possibly the war, in regards to her mental health and to her spiritual well being.
During these times, like many of you, I despair and even think of giving up. And like many of you, I also believe in a Higher Power whom I refer to as God. And currently, I am in the passenger seat, waiting to see where God is taking all of us.
For as this crisis unfolds for my family, God still is giving me signs of reassurement and hope.
Last week, I was asked to lunch by a local Dallas employee for CPS. Frankly, it was not my first encounter with CPS, but certainly my first encounter to break bread and to fellowship in a sense. So just the lunch invitation alone was a major shift in my world.
This person had attended my presentation in San Antonio last fall, where I spoke about NAMI and specifically about Visions for Tomorrow. I shared with the group also about my son and daughter and their struggle with mental illness. I remembered this woman specifically, because I recalled seeing tears in her eyes as she left the meeting.
The reason she asked me to lunch was to tell me that she had been moved and her heart had been touched by my sharing and teaching at this conference. She is fortunate to not have any major illnesses in her family, including mental illness. However, my story stayed with her, she said. She wanted me to know that she had felt compelled to go back to school to get her degree in counseling services, (I don’t recall specifically the type of degree) and that she was changing her career to work with children with mental illness. She thanked me and my family for being a blessing to her, even though she did not know us personally and she asked if she could remain in contact with me for input and advice as she progressed in her new journey. Her biggest desire was to have EMPATHY for the people she would be working with and to not always base her decisions upon what she had learned from a textbook. She wanted to see things through the eyes of the people she was working with and for.
I wept and I weep as I am writing this. I am glad to be a catalyst to move others to caring for our loved ones who are sick. I know that if my children had had MORE caring people to assist them, their roads would have been easier, even if the outcomes of each stage had not changed. And I weep because I was able to touch the heart of a stranger but I can not reach my own daughter and connect with her in the same fashion.
And so, while I will continue to reach out and hopefully touch as many people as I might be able to and that God chooses to use me for his Will, I also know that that it will not replace the grief I feel for my own daughter’s illness and lack of recovery. At this point, I am only able to reach for her by separating myself from her and that is scary and heartbreaking.
Teaching and sharing with others is not a trade off and it’s not a replacement. It’s what I do because I can. I want to be able to do more, especially for my daughter.
Thank you for letting me share with you today.
During these times, like many of you, I despair and even think of giving up. And like many of you, I also believe in a Higher Power whom I refer to as God. And currently, I am in the passenger seat, waiting to see where God is taking all of us.
For as this crisis unfolds for my family, God still is giving me signs of reassurement and hope.
Last week, I was asked to lunch by a local Dallas employee for CPS. Frankly, it was not my first encounter with CPS, but certainly my first encounter to break bread and to fellowship in a sense. So just the lunch invitation alone was a major shift in my world.
This person had attended my presentation in San Antonio last fall, where I spoke about NAMI and specifically about Visions for Tomorrow. I shared with the group also about my son and daughter and their struggle with mental illness. I remembered this woman specifically, because I recalled seeing tears in her eyes as she left the meeting.
The reason she asked me to lunch was to tell me that she had been moved and her heart had been touched by my sharing and teaching at this conference. She is fortunate to not have any major illnesses in her family, including mental illness. However, my story stayed with her, she said. She wanted me to know that she had felt compelled to go back to school to get her degree in counseling services, (I don’t recall specifically the type of degree) and that she was changing her career to work with children with mental illness. She thanked me and my family for being a blessing to her, even though she did not know us personally and she asked if she could remain in contact with me for input and advice as she progressed in her new journey. Her biggest desire was to have EMPATHY for the people she would be working with and to not always base her decisions upon what she had learned from a textbook. She wanted to see things through the eyes of the people she was working with and for.
I wept and I weep as I am writing this. I am glad to be a catalyst to move others to caring for our loved ones who are sick. I know that if my children had had MORE caring people to assist them, their roads would have been easier, even if the outcomes of each stage had not changed. And I weep because I was able to touch the heart of a stranger but I can not reach my own daughter and connect with her in the same fashion.
And so, while I will continue to reach out and hopefully touch as many people as I might be able to and that God chooses to use me for his Will, I also know that that it will not replace the grief I feel for my own daughter’s illness and lack of recovery. At this point, I am only able to reach for her by separating myself from her and that is scary and heartbreaking.
Teaching and sharing with others is not a trade off and it’s not a replacement. It’s what I do because I can. I want to be able to do more, especially for my daughter.
Thank you for letting me share with you today.
Wednesday, August 27, 2008
Life is what happens when you want to write.....
I have been meaning to post here, but frankly, can't find the time to write or anything that I think you might find interesting. Lots of things are going on.... school has started back and Caiti is a senior.... I hope. all kinds of speaking engagements are opening up for me. Like my house whose foundation was just recemented, I feel like life is on track but I have no idea where the train will end up past the horizon. Stay tuned, I will be back with more.
Sunday, July 27, 2008
It Doesn't End With Death
It’s been two and twenty years since you were here.
I’ve talked 'bout you a few times with close friends.
I’ve never written about you, the loss too great – you too dear.
Your death sent me into a spiral of chaos.
I died with you for a while.
No words can describe the depth of my loss.
And so many years after your death, there are times I think,
“I need to call him. He’d want to know this.”
We’re still that connected, love builds a strong link.
I’m not saying we would have stayed together, and grown old.
I’m not saying I always made you happy.
Loving you at times was a very heavy load.
You knew me. The knowing made me dread.
You cared for me. I let you.
You hurt me. I ran to you, even as I bled.
You called me your darling, your baby girl.
My skin would shiver at your words.
For I never knew when your rage would unfurl.
I loved you. Your dying turned me to steel.
I feared you. No need for that now.
There are so many other things I still do feel.
At times, for you, I still grieve.
So now, finally I write for you.
It’s not goodbye, just a partial reprieve.
I’ve talked 'bout you a few times with close friends.
I’ve never written about you, the loss too great – you too dear.
Your death sent me into a spiral of chaos.
I died with you for a while.
No words can describe the depth of my loss.
And so many years after your death, there are times I think,
“I need to call him. He’d want to know this.”
We’re still that connected, love builds a strong link.
I’m not saying we would have stayed together, and grown old.
I’m not saying I always made you happy.
Loving you at times was a very heavy load.
You knew me. The knowing made me dread.
You cared for me. I let you.
You hurt me. I ran to you, even as I bled.
You called me your darling, your baby girl.
My skin would shiver at your words.
For I never knew when your rage would unfurl.
I loved you. Your dying turned me to steel.
I feared you. No need for that now.
There are so many other things I still do feel.
At times, for you, I still grieve.
So now, finally I write for you.
It’s not goodbye, just a partial reprieve.
Sunday, June 22, 2008
Eliminate Stigma - Parity is just one more step
This email was sent out this weekend to many of my NAMI members and friends. Parity is a major issue for better medical treatment, better recovery plans, early detection and the elimination of stigma and discrimination. I thought I would share this with you, the readers as well.
The need for Parity Laws only demonstrates that discrimination is alive and well in this country. What do you do to eliminate any type of discrimination in your world? Are the organizations you belong to biracial? Is the neighborhood you live in multi-cultural? Being culturally diverse means more than eating at an ethnic restaurant. Just some ideas to ponder. Please read on.
Date: June 18, 2008
From: Marilyn Richmond, J.D., Assistant Executive Director
for Government Relations
American Psychological Association Practice
Organization
I am pleased to announce that the Senate and House have reached an
historic agreement on the terms for a final full mental health parity bill. The compromise is expected to move quickly through both chambers.
From the time that the House passed its version of the parity bill, H.R.1424, in early March (the Senate passed its version, S. 558, last September), the two chambers have been engaged in intense negotiationsto reconcile differences between the two bills. The APA Practice Organization has been deeply involved in these negotiations, along with other key stakeholders from the mental health, insurer, and employer communities, including the National Alliance on Mental Illness (NAMI), U.S. Chamber of Commerce, the National Retail Federation, America's Health Insurance Plans (AHIP), BlueCross BlueShield Association, and Aetna.
The final gap between the Senate and House bills was closed as
negotiations led to agreement over three key outstanding issues-
* Preemption. The House accepted the stronger Senate language, which
defers to the current HIPAA standard. This standard is extremely
protective of state law, ensuring that stronger state parity and other consumer laws will remain in place.
* Out-of-Network Services. The Senate accepted the stronger House
language that makes clear that out-of-network mental and substance use disorder services will be provided at parity when a plan provides out-of-network physical health services.
* Covered Services. The House agreed to drop mandated coverage for all DSM diagnoses but ensured that all mental health conditions and
substance use disorders would be covered by mirroring the standard for mental health under the current federal parity law.
Together, we have worked for the better part of a decade to end mental health and substance use benefits discrimination. This tremendous breakthrough would not have been possible without the tireless perseverance and dedication of psychologists across the country who have advocated year after year on behalf of their patients. When enacted the new federal parity law will-
* Completely end insurance discrimination against mental health and
substance use disorder benefits for over 113 million Americans,
requiring full parity coverage with physical health benefits.
* Extend to all aspects of plan coverage, including day/visit limits, dollar limits, coinsurance, copayments, deductibles and out-of-pocket maximums.
* Preserve strong state parity and consumer protection laws while
extending parity protection to 82 million more people who cannot be
protected by state laws.
* Ensure parity coverage for both in-network and out-of-network
services.
We will get back to you with further details on the bill and the process
ahead soon.
This is a great happening!!!
The need for Parity Laws only demonstrates that discrimination is alive and well in this country. What do you do to eliminate any type of discrimination in your world? Are the organizations you belong to biracial? Is the neighborhood you live in multi-cultural? Being culturally diverse means more than eating at an ethnic restaurant. Just some ideas to ponder. Please read on.
Date: June 18, 2008
From: Marilyn Richmond, J.D., Assistant Executive Director
for Government Relations
American Psychological Association Practice
Organization
I am pleased to announce that the Senate and House have reached an
historic agreement on the terms for a final full mental health parity bill. The compromise is expected to move quickly through both chambers.
From the time that the House passed its version of the parity bill, H.R.1424, in early March (the Senate passed its version, S. 558, last September), the two chambers have been engaged in intense negotiationsto reconcile differences between the two bills. The APA Practice Organization has been deeply involved in these negotiations, along with other key stakeholders from the mental health, insurer, and employer communities, including the National Alliance on Mental Illness (NAMI), U.S. Chamber of Commerce, the National Retail Federation, America's Health Insurance Plans (AHIP), BlueCross BlueShield Association, and Aetna.
The final gap between the Senate and House bills was closed as
negotiations led to agreement over three key outstanding issues-
* Preemption. The House accepted the stronger Senate language, which
defers to the current HIPAA standard. This standard is extremely
protective of state law, ensuring that stronger state parity and other consumer laws will remain in place.
* Out-of-Network Services. The Senate accepted the stronger House
language that makes clear that out-of-network mental and substance use disorder services will be provided at parity when a plan provides out-of-network physical health services.
* Covered Services. The House agreed to drop mandated coverage for all DSM diagnoses but ensured that all mental health conditions and
substance use disorders would be covered by mirroring the standard for mental health under the current federal parity law.
Together, we have worked for the better part of a decade to end mental health and substance use benefits discrimination. This tremendous breakthrough would not have been possible without the tireless perseverance and dedication of psychologists across the country who have advocated year after year on behalf of their patients. When enacted the new federal parity law will-
* Completely end insurance discrimination against mental health and
substance use disorder benefits for over 113 million Americans,
requiring full parity coverage with physical health benefits.
* Extend to all aspects of plan coverage, including day/visit limits, dollar limits, coinsurance, copayments, deductibles and out-of-pocket maximums.
* Preserve strong state parity and consumer protection laws while
extending parity protection to 82 million more people who cannot be
protected by state laws.
* Ensure parity coverage for both in-network and out-of-network
services.
We will get back to you with further details on the bill and the process
ahead soon.
This is a great happening!!!
Saturday, June 14, 2008
I' m an Action Kind of Girl
I’m sick right now. It happens about once a year. Allergies combined with stress and a runny nose turns into a cold into whatever and knocks me down for a day or two.
I hate being sick, but I have to admit that the down time gives some time to ponder things I don’t take time for usually. Maybe it’s the cough syrup but my mind jumps in and out and I come up with some of my funnies one liners and best ideas for future projects during this time. If I remember them when I wake up…..
I was kind of half in, half out, watching “Sleepless in Seattle”. A chick flick from way back that I somehow have missed for all these years. Not a great movie since I missed most of it dozing, but it did bring up the idea of what makes a great love relationship. What I got out of it was Meg Ryan was in love with one guy but was drawn to another that she heard over the radio. Everything about guy #1 seemed perfect for her, but she kept getting these “signs” that something else lay out there for her. And it did – a guy who lived on the opposite side of the country, with a half grown kid. Oooookay.
So what about this love thing? I have been in love several times. Almost as many times as Elizabeth Taylor. Many people are hooked into thinking that we all have this one soul mate. However, if you are going to buy into that idea and the soul is something that is a part of heaven and lives forever, doesn’t it make sense that maybe you have more than one soul mate? Or at least soul connections? Soul friends? Soul acquaintances? Souls passing in the night? Soul one-night stands?
Okay… so I’m being a bit silly, but my point is – if we are expected to have generosity and compassion and empathy for all men as in peace on earth, good will to man, doesn’t it make sense that we also have great capacity to love and to love many?
While you roll that over and pick at it, let me share this with you. I have had the opportunity to love several men romantically. I married most of them. And in the past year or so, I have had the opportunity to have two of them come back into my life and reconnect for a bit.
And in conclusion, love is not enough to build a future on.
Oh wait, I left parts out. Just consider you have read the last paragraph of a really long news article and now you will go back to pick up the details. I do that all the time.
The first reconnect was my ex-husband who is my daughters’ father. I loved that man in a way that kept me connected to him like a bee just has to make honey. He was good looking, smart, a great conversationalist, liked to try new things and was, if not great in bed, at least long lasting enough for me to get the rest done.
He was also self centered, selfish, narcissistic, paranoid, a liar, a mind manipulator and his favorite saying was “I am who I am because of my mother. If I killed someone and buried them in the back yard, she would just help me cove it up and tell me they deserved it.”
Oh, and he was and still is gay. And the gay part is not what ruined our marriage. It was the stuff listed above that did.
And when he came back into my life and my daughter’s life after 16 years, he was still gay. But he promised me that all the other things listed above were no longer true. So I was willing to listen to him.
And I thought to myself, while I don’t need him as a husband, if he is all the good things he used to be and none of the bad things, what a great friend he could be to the daughter he had not been a father to.
And looking in my heart, I saw that I had good feelings for him still and he spent several months showing me the “new” him. So I let him back into her life. What a mistake!!
The “new” him was just a highly developed “old” him, whose purpose was to deceive those around him to support his need to control and manipulate. And 12 months later, we are still dealing with the damage he created for my daughter and our family and I don’t know that this will ever be a closed chapter in her life. So I will have to continue revisiting it with her, for her. She loves her father. I love her father. Love didn’t help either of us.
If I had not been able to recall the love I had had for him, I might have still made the same decision in an effort to better her life and let her have some closure on old wounds he created for her.
HOWEVER, if I had not been able to recall that past love, I might not have been so easily deceived. I thought I was being so careful for her sake, laying down rules, drawing out boundaries – remembering his old tricks and trying to second guess how he could use them against us today, in the now.
Love makes you vulnerable to having your heart used against you though. I so wanted him to care for our daughter and for her to not feel that he had abandoned her – that it had all been a mistake. So in a way, my love for her also created this scene where I feel that I failed to protect her as well.
The second reconnect was my first love. We were never married but together during high school. I have many fond memories of him and our time together. He made me feel cared for and important and safe. In his senior year, he decided to join the marines. This was a lifestyle I did not want for myself and I was angry at him for picking it and not asking me what I thought.
In a recent conversation, he asked why I didn’t speak up about what I thought. The answer to that is because I didn’t want to infringe on his dream in the same way he had infringed on mine. My lack of maturity and lack of knowing my own self prevented me from doing a lot of things. Consequently, I became distant and angry.
Now I know that I was actually suffering from depression that became worse when he left. He’s angry or was, I think, because all he sees is that I broke off because he was leaving. I refused to see him when he came home or take his calls. I couldn’t. It was physically and mentally painful to even think about him. I saw myself stuck in a no win situation and felt that I was drowning. The only security I had known since my parents divorce had walked away from me.
We reconnected after many years. We had lunch. I was nervous and became even more so as the lunch progressed as I realized that I felt just exactly as I did in high school towards him. That spark was there. But I also carry a spark for my love that died when I was 25. And for my daughters’ father; sick, perverse human that he is. And I carry a spark for my husband now.
So how does one pick which spark is the spark they want to live with, be with?
My first love is living a life that many people would love. He was in the military and traveled a lot. But he was also away from his family a lot. I wouldn’t have liked that at all. I don’t now what kind of husband he turned out to be or a father. But not having him home every night is a deal breaker in the plan for my life. And he showed me that when he joined the marines. It’s not a bad life, it’s just not the life I wanted if I were going to be married and build a family.
In our talks, he says we are friends. But I find his definition of friend and mine to be very different. I like calling my friends to share what is going on in our lives. I now I can call them anytime, and they can and do call me anytime. To me – a really good friendship is as intense and committed as a marriage, just without the sex.
I love my friends and like caring for them. He seems content with a chat on the internet about his latest work project once every few months. We’re not connected and it makes me sad. I would like to have someone in my life that knew me in my teens to talk about things.
My ex-husband is just not a whole person. His being gay is not the issue. His being mentally and morally corrupt in his assessment of what his duties are to others and how to treat people is the issues. If he had stayed in my life, I am sure I would have had a nervous breakdown or worse.
So what about the spark that is a part of my life now? He’s home with me. He supports me in what I do… so much that I was able to tell him about lunch with my ex-boyfriend and consequent chats and conversations later. So that makes him my best friend as well. And he has taken good care of my children, the ones he didn’t father but did parent like his own. And our major fights are about when he thinks he is not doing a good enough job and is letting me down. Imagine! A man who worries about doing enough for his family!
Love is wonderful. I love being in love and all that implies. But even more so, I love being cared for and thought about. That makes up for a lot of other things that love just doesn’t start to cover. Love is the emotion. Being cared for is the act.
I’m an action kind of girl.
I hate being sick, but I have to admit that the down time gives some time to ponder things I don’t take time for usually. Maybe it’s the cough syrup but my mind jumps in and out and I come up with some of my funnies one liners and best ideas for future projects during this time. If I remember them when I wake up…..
I was kind of half in, half out, watching “Sleepless in Seattle”. A chick flick from way back that I somehow have missed for all these years. Not a great movie since I missed most of it dozing, but it did bring up the idea of what makes a great love relationship. What I got out of it was Meg Ryan was in love with one guy but was drawn to another that she heard over the radio. Everything about guy #1 seemed perfect for her, but she kept getting these “signs” that something else lay out there for her. And it did – a guy who lived on the opposite side of the country, with a half grown kid. Oooookay.
So what about this love thing? I have been in love several times. Almost as many times as Elizabeth Taylor. Many people are hooked into thinking that we all have this one soul mate. However, if you are going to buy into that idea and the soul is something that is a part of heaven and lives forever, doesn’t it make sense that maybe you have more than one soul mate? Or at least soul connections? Soul friends? Soul acquaintances? Souls passing in the night? Soul one-night stands?
Okay… so I’m being a bit silly, but my point is – if we are expected to have generosity and compassion and empathy for all men as in peace on earth, good will to man, doesn’t it make sense that we also have great capacity to love and to love many?
While you roll that over and pick at it, let me share this with you. I have had the opportunity to love several men romantically. I married most of them. And in the past year or so, I have had the opportunity to have two of them come back into my life and reconnect for a bit.
And in conclusion, love is not enough to build a future on.
Oh wait, I left parts out. Just consider you have read the last paragraph of a really long news article and now you will go back to pick up the details. I do that all the time.
The first reconnect was my ex-husband who is my daughters’ father. I loved that man in a way that kept me connected to him like a bee just has to make honey. He was good looking, smart, a great conversationalist, liked to try new things and was, if not great in bed, at least long lasting enough for me to get the rest done.
He was also self centered, selfish, narcissistic, paranoid, a liar, a mind manipulator and his favorite saying was “I am who I am because of my mother. If I killed someone and buried them in the back yard, she would just help me cove it up and tell me they deserved it.”
Oh, and he was and still is gay. And the gay part is not what ruined our marriage. It was the stuff listed above that did.
And when he came back into my life and my daughter’s life after 16 years, he was still gay. But he promised me that all the other things listed above were no longer true. So I was willing to listen to him.
And I thought to myself, while I don’t need him as a husband, if he is all the good things he used to be and none of the bad things, what a great friend he could be to the daughter he had not been a father to.
And looking in my heart, I saw that I had good feelings for him still and he spent several months showing me the “new” him. So I let him back into her life. What a mistake!!
The “new” him was just a highly developed “old” him, whose purpose was to deceive those around him to support his need to control and manipulate. And 12 months later, we are still dealing with the damage he created for my daughter and our family and I don’t know that this will ever be a closed chapter in her life. So I will have to continue revisiting it with her, for her. She loves her father. I love her father. Love didn’t help either of us.
If I had not been able to recall the love I had had for him, I might have still made the same decision in an effort to better her life and let her have some closure on old wounds he created for her.
HOWEVER, if I had not been able to recall that past love, I might not have been so easily deceived. I thought I was being so careful for her sake, laying down rules, drawing out boundaries – remembering his old tricks and trying to second guess how he could use them against us today, in the now.
Love makes you vulnerable to having your heart used against you though. I so wanted him to care for our daughter and for her to not feel that he had abandoned her – that it had all been a mistake. So in a way, my love for her also created this scene where I feel that I failed to protect her as well.
The second reconnect was my first love. We were never married but together during high school. I have many fond memories of him and our time together. He made me feel cared for and important and safe. In his senior year, he decided to join the marines. This was a lifestyle I did not want for myself and I was angry at him for picking it and not asking me what I thought.
In a recent conversation, he asked why I didn’t speak up about what I thought. The answer to that is because I didn’t want to infringe on his dream in the same way he had infringed on mine. My lack of maturity and lack of knowing my own self prevented me from doing a lot of things. Consequently, I became distant and angry.
Now I know that I was actually suffering from depression that became worse when he left. He’s angry or was, I think, because all he sees is that I broke off because he was leaving. I refused to see him when he came home or take his calls. I couldn’t. It was physically and mentally painful to even think about him. I saw myself stuck in a no win situation and felt that I was drowning. The only security I had known since my parents divorce had walked away from me.
We reconnected after many years. We had lunch. I was nervous and became even more so as the lunch progressed as I realized that I felt just exactly as I did in high school towards him. That spark was there. But I also carry a spark for my love that died when I was 25. And for my daughters’ father; sick, perverse human that he is. And I carry a spark for my husband now.
So how does one pick which spark is the spark they want to live with, be with?
My first love is living a life that many people would love. He was in the military and traveled a lot. But he was also away from his family a lot. I wouldn’t have liked that at all. I don’t now what kind of husband he turned out to be or a father. But not having him home every night is a deal breaker in the plan for my life. And he showed me that when he joined the marines. It’s not a bad life, it’s just not the life I wanted if I were going to be married and build a family.
In our talks, he says we are friends. But I find his definition of friend and mine to be very different. I like calling my friends to share what is going on in our lives. I now I can call them anytime, and they can and do call me anytime. To me – a really good friendship is as intense and committed as a marriage, just without the sex.
I love my friends and like caring for them. He seems content with a chat on the internet about his latest work project once every few months. We’re not connected and it makes me sad. I would like to have someone in my life that knew me in my teens to talk about things.
My ex-husband is just not a whole person. His being gay is not the issue. His being mentally and morally corrupt in his assessment of what his duties are to others and how to treat people is the issues. If he had stayed in my life, I am sure I would have had a nervous breakdown or worse.
So what about the spark that is a part of my life now? He’s home with me. He supports me in what I do… so much that I was able to tell him about lunch with my ex-boyfriend and consequent chats and conversations later. So that makes him my best friend as well. And he has taken good care of my children, the ones he didn’t father but did parent like his own. And our major fights are about when he thinks he is not doing a good enough job and is letting me down. Imagine! A man who worries about doing enough for his family!
Love is wonderful. I love being in love and all that implies. But even more so, I love being cared for and thought about. That makes up for a lot of other things that love just doesn’t start to cover. Love is the emotion. Being cared for is the act.
I’m an action kind of girl.
Thursday, June 5, 2008
Let's talk about bipolar disorder
From the National Institute of Mental Health
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person's mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe. They can result in damaged relationships, poor job or school performance, and even suicide. But there is good news: bipolar disorder can be treated, and people with this illness can lead full and productive lives.
More than 2 million American adults, or about 1 percent of the population age 18 and older in any given year, have bipolar disorder. Bipolar disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life.
What Are the Symptoms of Bipolar Disorder?
Bipolar disorder causes dramatic mood swings-from overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.
Signs and symptoms of mania (or a manic episode) include:
* Increased energy, activity, and restlessness
* Excessively "high," overly good, euphoric mood
* Extreme irritability
* Racing thoughts and talking very fast, jumping from one idea to another
* Distractibility, can't concentrate well
* Little sleep needed
* Unrealistic beliefs in one's abilities and powers
* Poor judgment
* Spending sprees
* A lasting period of behavior that is different from usual
* Increased sexual drive
* Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
* Provocative, intrusive, or aggressive behavior
* Denial that anything is wrong
A manic episode is diagnosed if elevated mood occurs with 3 or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, 4 additional symptoms must be present.
Signs and symptoms of depression (or a depressive episode) include:
* Lasting sad, anxious, or empty mood
* Feelings of hopelessness or pessimism
* Feelings of guilt, worthlessness, or helplessness
* Loss of interest or pleasure in activities once enjoyed, including sex
* Decreased energy, a feeling of fatigue or of being "slowed down"
* Difficulty concentrating, remembering, making decisions
* Restlessness or irritability
* Sleeping too much, or can't sleep
* Change in appetite and/or unintended weight loss or gain
* Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
* Thoughts of death or suicide, or suicide attempts
A depressive episode is diagnosed if 5 or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.
A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.
Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person's usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness.
It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood, which many people call "the blues" when it is short-lived but is termed "dysthymia" when it is chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania), and then severe mania.
In some people, however, symptoms of mania and depression may occur together in what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad, hopeless mood while at the same time feeling extremely energized.
Bipolar disorder may appear to be a problem other than mental illness-for instance, alcohol or drug abuse, poor school or work performance, or strained interpersonal relationships. Such problems in fact may be signs of an underlying mood disorder.
Diagnosis of Bipolar Disorder
Like other mental illnesses, bipolar disorder cannot yet be identified physiologically-for example, through a blood test or a brain scan. Therefore, a diagnosis of bipolar disorder is made on the basis of symptoms, course of illness, and, when available, family history. The diagnostic criteria for bipolar disorder are described in the Diagnostic and Statistical Manual for Mental Disorders, fourth edition (DSM-IV).
Descriptions offered by people with bipolar disorder give valuable insights into the various mood states associated with the illness:
Depression: I doubt completely my ability to do anything well. It seems as though my mind has slowed down and burned out to the point of being virtually useless. [I am] haunt[ed] with the total, the desperate hopelessness of it all. Others say, "It's only temporary, it will pass, you will get over it," but of course they haven't any idea of how I feel, although they are certain they do. If I can't feel, move, think or care, then what on earth is the point?
Hypomania: At first when I'm high, it's tremendous ideas are fast like shooting stars you follow until brighter ones appear. All shyness disappears, the right words and gestures are suddenly there uninteresting people, things become intensely interesting. Sensuality is pervasive, the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria, you can do anything, but, somewhere this changes.
Mania: The fast ideas become too fast and there are far too many overwhelming confusion replaces clarity you stop keeping up with it-memory goes. Infectious humor ceases to amuse. Your friends become frightened. Everything is now against the grain you are irritable, angry, frightened, uncontrollable, and trapped.
Suicide
Some people with bipolar disorder become suicidal. Anyone who is thinking about committing suicide needs immediate attention, preferably from a mental health professional or a physician. Anyone who talks about suicide should be taken seriously. Risk for suicide appears to be higher earlier in the course of the illness. Therefore, recognizing bipolar disorder early and learning how best to manage it may decrease the risk of death by suicide.
Signs and symptoms that may accompany suicidal feelings include:
* talking about feeling suicidal or wanting to die
* feeling hopeless, that nothing will ever change or get better
* feeling helpless, that nothing one does makes any difference
* abusing alcohol or drugs
* feeling like a burden to family and friends
* putting affairs in order (e.g., organizing finances or giving away possessions to *prepare for one's death)
* writing a suicide note
* putting oneself in harm's way, or in situations where there is a danger of being killed
What Is the Course of Bipolar Disorder?
Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms, but as many as one-third of people have some residual symptoms. A small percentage of people experience chronic unremitting symptoms despite treatment.
The classic form of the illness, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression; this form of the illness is called bipolar II disorder. When 4 or more episodes of illness occur within a 12-month period, a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than among men.
People with bipolar disorder can lead healthy and productive lives when the illness is effectively treated. Without treatment, however, the natural course of bipolar disorder tends to worsen. Over time a person may suffer more frequent (more rapid-cycling) and more severe manic and depressive episodes than those experienced when the illness first appeared. But in most cases, proper treatment can help reduce the frequency and severity of episodes and can help people with bipolar disorder maintain good quality of life.
What Causes Bipolar Disorder?
Scientists are learning about the possible causes of bipolar disorder through several kinds of studies. Most scientists now agree that there is no single cause for bipolar disorder-rather, many factors act together to produce the illness.
Because bipolar disorder tends to run in families, researchers have been searching for specific genes-the microscopic "building blocks" of DNA inside all cells that influence how the body and mind work and grow-passed down through generations that may increase a person's chance of developing the illness. But genes are not the whole story. Studies of identical twins, who share all the same genes, indicate that both genes and other factors play a role in bipolar disorder. If bipolar disorder were caused entirely by genes, then the identical twin of someone with the illness would always develop the illness, and research has shown that this is not the case. But if one twin has bipolar disorder, the other twin is more likely to develop the illness than is another sibling.
In addition, findings from gene research suggest that bipolar disorder, like other mental illnesses, does not occur because of a single gene. It appears likely that many different genes act together, and in combination with other factors of the person or the person's environment, to cause bipolar disorder. Finding these genes, each of which contributes only a small amount toward the vulnerability to bipolar disorder, has been extremely difficult. But scientists expect that the advanced research tools now being used will lead to these discoveries and to new and better treatments for bipolar disorder.
Brain-imaging studies are helping scientists learn what goes wrong in the brain to produce bipolar disorder and other mental illnesses. , New brain-imaging techniques allow researchers to take pictures of the living brain at work, to examine its structure and activity, without the need for surgery or other invasive procedures. These techniques include magnetic resonance imaging (MRI), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI). There is evidence from imaging studies that the brains of people with bipolar disorder may differ from the brains of healthy individuals. As the differences are more clearly identified and defined through research, scientists will gain a better understanding of the underlying causes of the illness, and eventually may be able to predict which types of treatment will work most effectively.
How Is Bipolar Disorder Treated?
Most people with bipolar disorder-even those with the most severe forms-can achieve substantial stabilization of their mood swings and related symptoms with proper treatment. Because bipolar disorder is a recurrent illness, long-term preventive treatment is strongly recommended and almost always indicated. A strategy that combines medication and psychosocial treatment is optimal for managing the disorder over time.
In most cases, bipolar disorder is much better controlled if treatment is continuous than if it is on and off. But even when there are no breaks in treatment, mood changes can occur and should be reported immediately to your doctor. The doctor may be able to prevent a full-blown episode by making adjustments to the treatment plan. Working closely with the doctor and communicating openly about treatment concerns and options can make a difference in treatment effectiveness.
In addition, keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events may help people with bipolar disorder and their families to better understand the illness. This chart also can help the doctor track and treat the illness most effectively.
This publication, written by Melissa Spearing of NIMH, is a revision and update of an earlier version by Mary Lynn Hendrix. Scientific information and review were provided by NIMH Director Steven E. Hyman, M.D., and other NIMH staff members Matthew V. Rudorfer, M.D., and Jane L. Pearson, Ph.D. Editorial assistance was provided by Clarissa K. Wittenberg, Margaret Strock, and Lisa D. Alberts of NIMH.
NIH Publication No. 02-3679
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person's mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe. They can result in damaged relationships, poor job or school performance, and even suicide. But there is good news: bipolar disorder can be treated, and people with this illness can lead full and productive lives.
More than 2 million American adults, or about 1 percent of the population age 18 and older in any given year, have bipolar disorder. Bipolar disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life.
What Are the Symptoms of Bipolar Disorder?
Bipolar disorder causes dramatic mood swings-from overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.
Signs and symptoms of mania (or a manic episode) include:
* Increased energy, activity, and restlessness
* Excessively "high," overly good, euphoric mood
* Extreme irritability
* Racing thoughts and talking very fast, jumping from one idea to another
* Distractibility, can't concentrate well
* Little sleep needed
* Unrealistic beliefs in one's abilities and powers
* Poor judgment
* Spending sprees
* A lasting period of behavior that is different from usual
* Increased sexual drive
* Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
* Provocative, intrusive, or aggressive behavior
* Denial that anything is wrong
A manic episode is diagnosed if elevated mood occurs with 3 or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, 4 additional symptoms must be present.
Signs and symptoms of depression (or a depressive episode) include:
* Lasting sad, anxious, or empty mood
* Feelings of hopelessness or pessimism
* Feelings of guilt, worthlessness, or helplessness
* Loss of interest or pleasure in activities once enjoyed, including sex
* Decreased energy, a feeling of fatigue or of being "slowed down"
* Difficulty concentrating, remembering, making decisions
* Restlessness or irritability
* Sleeping too much, or can't sleep
* Change in appetite and/or unintended weight loss or gain
* Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
* Thoughts of death or suicide, or suicide attempts
A depressive episode is diagnosed if 5 or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.
A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.
Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person's usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness.
It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood, which many people call "the blues" when it is short-lived but is termed "dysthymia" when it is chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania), and then severe mania.
In some people, however, symptoms of mania and depression may occur together in what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad, hopeless mood while at the same time feeling extremely energized.
Bipolar disorder may appear to be a problem other than mental illness-for instance, alcohol or drug abuse, poor school or work performance, or strained interpersonal relationships. Such problems in fact may be signs of an underlying mood disorder.
Diagnosis of Bipolar Disorder
Like other mental illnesses, bipolar disorder cannot yet be identified physiologically-for example, through a blood test or a brain scan. Therefore, a diagnosis of bipolar disorder is made on the basis of symptoms, course of illness, and, when available, family history. The diagnostic criteria for bipolar disorder are described in the Diagnostic and Statistical Manual for Mental Disorders, fourth edition (DSM-IV).
Descriptions offered by people with bipolar disorder give valuable insights into the various mood states associated with the illness:
Depression: I doubt completely my ability to do anything well. It seems as though my mind has slowed down and burned out to the point of being virtually useless. [I am] haunt[ed] with the total, the desperate hopelessness of it all. Others say, "It's only temporary, it will pass, you will get over it," but of course they haven't any idea of how I feel, although they are certain they do. If I can't feel, move, think or care, then what on earth is the point?
Hypomania: At first when I'm high, it's tremendous ideas are fast like shooting stars you follow until brighter ones appear. All shyness disappears, the right words and gestures are suddenly there uninteresting people, things become intensely interesting. Sensuality is pervasive, the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria, you can do anything, but, somewhere this changes.
Mania: The fast ideas become too fast and there are far too many overwhelming confusion replaces clarity you stop keeping up with it-memory goes. Infectious humor ceases to amuse. Your friends become frightened. Everything is now against the grain you are irritable, angry, frightened, uncontrollable, and trapped.
Suicide
Some people with bipolar disorder become suicidal. Anyone who is thinking about committing suicide needs immediate attention, preferably from a mental health professional or a physician. Anyone who talks about suicide should be taken seriously. Risk for suicide appears to be higher earlier in the course of the illness. Therefore, recognizing bipolar disorder early and learning how best to manage it may decrease the risk of death by suicide.
Signs and symptoms that may accompany suicidal feelings include:
* talking about feeling suicidal or wanting to die
* feeling hopeless, that nothing will ever change or get better
* feeling helpless, that nothing one does makes any difference
* abusing alcohol or drugs
* feeling like a burden to family and friends
* putting affairs in order (e.g., organizing finances or giving away possessions to *prepare for one's death)
* writing a suicide note
* putting oneself in harm's way, or in situations where there is a danger of being killed
What Is the Course of Bipolar Disorder?
Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms, but as many as one-third of people have some residual symptoms. A small percentage of people experience chronic unremitting symptoms despite treatment.
The classic form of the illness, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression; this form of the illness is called bipolar II disorder. When 4 or more episodes of illness occur within a 12-month period, a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than among men.
People with bipolar disorder can lead healthy and productive lives when the illness is effectively treated. Without treatment, however, the natural course of bipolar disorder tends to worsen. Over time a person may suffer more frequent (more rapid-cycling) and more severe manic and depressive episodes than those experienced when the illness first appeared. But in most cases, proper treatment can help reduce the frequency and severity of episodes and can help people with bipolar disorder maintain good quality of life.
What Causes Bipolar Disorder?
Scientists are learning about the possible causes of bipolar disorder through several kinds of studies. Most scientists now agree that there is no single cause for bipolar disorder-rather, many factors act together to produce the illness.
Because bipolar disorder tends to run in families, researchers have been searching for specific genes-the microscopic "building blocks" of DNA inside all cells that influence how the body and mind work and grow-passed down through generations that may increase a person's chance of developing the illness. But genes are not the whole story. Studies of identical twins, who share all the same genes, indicate that both genes and other factors play a role in bipolar disorder. If bipolar disorder were caused entirely by genes, then the identical twin of someone with the illness would always develop the illness, and research has shown that this is not the case. But if one twin has bipolar disorder, the other twin is more likely to develop the illness than is another sibling.
In addition, findings from gene research suggest that bipolar disorder, like other mental illnesses, does not occur because of a single gene. It appears likely that many different genes act together, and in combination with other factors of the person or the person's environment, to cause bipolar disorder. Finding these genes, each of which contributes only a small amount toward the vulnerability to bipolar disorder, has been extremely difficult. But scientists expect that the advanced research tools now being used will lead to these discoveries and to new and better treatments for bipolar disorder.
Brain-imaging studies are helping scientists learn what goes wrong in the brain to produce bipolar disorder and other mental illnesses. , New brain-imaging techniques allow researchers to take pictures of the living brain at work, to examine its structure and activity, without the need for surgery or other invasive procedures. These techniques include magnetic resonance imaging (MRI), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI). There is evidence from imaging studies that the brains of people with bipolar disorder may differ from the brains of healthy individuals. As the differences are more clearly identified and defined through research, scientists will gain a better understanding of the underlying causes of the illness, and eventually may be able to predict which types of treatment will work most effectively.
How Is Bipolar Disorder Treated?
Most people with bipolar disorder-even those with the most severe forms-can achieve substantial stabilization of their mood swings and related symptoms with proper treatment. Because bipolar disorder is a recurrent illness, long-term preventive treatment is strongly recommended and almost always indicated. A strategy that combines medication and psychosocial treatment is optimal for managing the disorder over time.
In most cases, bipolar disorder is much better controlled if treatment is continuous than if it is on and off. But even when there are no breaks in treatment, mood changes can occur and should be reported immediately to your doctor. The doctor may be able to prevent a full-blown episode by making adjustments to the treatment plan. Working closely with the doctor and communicating openly about treatment concerns and options can make a difference in treatment effectiveness.
In addition, keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events may help people with bipolar disorder and their families to better understand the illness. This chart also can help the doctor track and treat the illness most effectively.
This publication, written by Melissa Spearing of NIMH, is a revision and update of an earlier version by Mary Lynn Hendrix. Scientific information and review were provided by NIMH Director Steven E. Hyman, M.D., and other NIMH staff members Matthew V. Rudorfer, M.D., and Jane L. Pearson, Ph.D. Editorial assistance was provided by Clarissa K. Wittenberg, Margaret Strock, and Lisa D. Alberts of NIMH.
NIH Publication No. 02-3679
Wednesday, June 4, 2008
Assessing the Economic Costs of Serious Mental Illness
Assessing the Economic Costs of Serious Mental Illness
Thomas R. Insel, M.D.
It goes without saying that the excess costs of untreated or poorly treated mental illness in the disability system, in prisons, and on the streets are part of the mental health care crisis. We are spending too much on mental illness in all the wrong places. And the consequences for consumers are worse than the costs for taxpayers.
Michael F. Hogan (1)
What do mental disorders cost the nation? The costs of health care are considered one of the greatest challenges in U.S. public policy (2). In 2006, health care costs reached 16% of the nation's gross domestic product, on a path to reach 20% by 2016 (3). While mental disorders contribute to these costs at an estimated 6.2% of the nation's spending on health care (4), the full economic costs of mental disorders are not captured by an analysis of health care costs. Unlike other medical disorders, the costs of mental disorders are more "indirect" than "direct." The costs of care (e.g., medication, clinic visits, or hospitalization) are direct costs. Indirect costs are incurred through reduced labor supply, public income support payments, reduced educational attainment, and costs associated with other consequences such as incarceration or homelessness. Another kind of indirect cost results from the high rate of medical complications associated with serious mental illness, leading to high rates of emergency room care, high prevalence of pulmonary disease (persons with serious mental illness smoke 44% of all cigarettes in the United States), and early mortality (a loss of 13 to 32 years) (5). While indirect costs have been challenging to quantify, they are critical for informing public policy. Once we assess the key components of the economic burden of mental disorders, we can have a more informed discussion about what should be invested to prevent and treat these illnesses.
This issue of the Journal includes an important report by Kessler et al. (6) that focuses on one source of indirect costs: the costs from loss of earnings. The analysis is based on the National Comorbidity Survey Replication (NCS-R), a population-based epidemiological study of mental disorders. In this survey, data from nearly 5,000 individuals were used to estimate loss of earnings by comparing earnings in the previous 12 months of persons with mental disorders with 12-month earnings of persons without mental disorders. The analysis focused on individuals with serious mental illness. The results, based on a generalized linear model analysis, demonstrate a mean reduction in earnings of $16,306 in persons with serious mental illness (both with and without any earnings) and also that about 75% of the total reduction in earnings came from individuals who had some earnings in the prior year (versus those who did not have any earnings at all). By extrapolating these individual results to the general population, the authors estimated that serious mental illness is associated with an annual loss of earnings totaling $193.2 billion.
There are several surprises in this report. One is the gender difference in earnings: even when the earnings of men with serious mental illness dropped to $28,070 (compared with men without serious mental illness), these earnings were still higher than earnings in women without serious mental illness. This result cannot be explained by a large number of women outside of the workforce, because analysis of those subjects with positive earnings only demonstrated the same profound difference in earnings based on gender. A second unexpected finding is that the loss of earnings is not mainly a function of chronic unemployment. Finally, when one extends these findings to the general population, the financial loss is considerably larger than previous estimates (7, 8), which seems only partly explained by inflationary considerations.
While $193.2 billion seems enormous, it is important to recognize that the NCS-R yields a conservative sample for estimating economic impact. As a door-to-door survey, NCS-R did not assess individuals hospitalized in institutions, incarcerated in prisons or jails, or who are homeless. Indeed, NCS-R had so few subjects with schizophrenia or autism that these diagnoses were not part of the original epidemiological analysis, even though both are associated with chronic disability and lifelong loss of income on a far greater per capita basis than mood or anxiety disorders.
Accepting this conservative estimate of a loss of $193.2 billion in earnings each year from serious mental illness, can we estimate the total economic impact of serious mental illness? In Table 1 we begin to answer this question, adding the new estimates of income loss to data from 2002 on the direct costs of health care and disability benefits, including Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) cash assistance, food stamps, and public housing financed by federal and state revenues. Missing are the costs of health care for comorbid conditions. Missing are estimates for the loss of productivity due to premature death and the loss of productivity of those with serious mental illness who are institutionalized, incarcerated, or homeless. Missing is the cost of incarceration, although as many as 22% of individuals in jails and prisons have been diagnosed with mental illness (9). Missing is the cost of homelessness, although approximately one third of adult homelessness is associated with serious mental illness (8). And, of course, missing from any such tabulation is the cost to family members who bear much of the emotional and financial burden of these illnesses. The $317 billion estimated economic burden of serious mental illness in Table 1 excludes costs associated with comorbid conditions, incarceration, homelessness, and early mortality, yet this sum is equivalent to more than $1,000/year for every man, woman, and child in the United States.
Thomas R. Insel, M.D.
It goes without saying that the excess costs of untreated or poorly treated mental illness in the disability system, in prisons, and on the streets are part of the mental health care crisis. We are spending too much on mental illness in all the wrong places. And the consequences for consumers are worse than the costs for taxpayers.
Michael F. Hogan (1)
What do mental disorders cost the nation? The costs of health care are considered one of the greatest challenges in U.S. public policy (2). In 2006, health care costs reached 16% of the nation's gross domestic product, on a path to reach 20% by 2016 (3). While mental disorders contribute to these costs at an estimated 6.2% of the nation's spending on health care (4), the full economic costs of mental disorders are not captured by an analysis of health care costs. Unlike other medical disorders, the costs of mental disorders are more "indirect" than "direct." The costs of care (e.g., medication, clinic visits, or hospitalization) are direct costs. Indirect costs are incurred through reduced labor supply, public income support payments, reduced educational attainment, and costs associated with other consequences such as incarceration or homelessness. Another kind of indirect cost results from the high rate of medical complications associated with serious mental illness, leading to high rates of emergency room care, high prevalence of pulmonary disease (persons with serious mental illness smoke 44% of all cigarettes in the United States), and early mortality (a loss of 13 to 32 years) (5). While indirect costs have been challenging to quantify, they are critical for informing public policy. Once we assess the key components of the economic burden of mental disorders, we can have a more informed discussion about what should be invested to prevent and treat these illnesses.
This issue of the Journal includes an important report by Kessler et al. (6) that focuses on one source of indirect costs: the costs from loss of earnings. The analysis is based on the National Comorbidity Survey Replication (NCS-R), a population-based epidemiological study of mental disorders. In this survey, data from nearly 5,000 individuals were used to estimate loss of earnings by comparing earnings in the previous 12 months of persons with mental disorders with 12-month earnings of persons without mental disorders. The analysis focused on individuals with serious mental illness. The results, based on a generalized linear model analysis, demonstrate a mean reduction in earnings of $16,306 in persons with serious mental illness (both with and without any earnings) and also that about 75% of the total reduction in earnings came from individuals who had some earnings in the prior year (versus those who did not have any earnings at all). By extrapolating these individual results to the general population, the authors estimated that serious mental illness is associated with an annual loss of earnings totaling $193.2 billion.
There are several surprises in this report. One is the gender difference in earnings: even when the earnings of men with serious mental illness dropped to $28,070 (compared with men without serious mental illness), these earnings were still higher than earnings in women without serious mental illness. This result cannot be explained by a large number of women outside of the workforce, because analysis of those subjects with positive earnings only demonstrated the same profound difference in earnings based on gender. A second unexpected finding is that the loss of earnings is not mainly a function of chronic unemployment. Finally, when one extends these findings to the general population, the financial loss is considerably larger than previous estimates (7, 8), which seems only partly explained by inflationary considerations.
While $193.2 billion seems enormous, it is important to recognize that the NCS-R yields a conservative sample for estimating economic impact. As a door-to-door survey, NCS-R did not assess individuals hospitalized in institutions, incarcerated in prisons or jails, or who are homeless. Indeed, NCS-R had so few subjects with schizophrenia or autism that these diagnoses were not part of the original epidemiological analysis, even though both are associated with chronic disability and lifelong loss of income on a far greater per capita basis than mood or anxiety disorders.
Accepting this conservative estimate of a loss of $193.2 billion in earnings each year from serious mental illness, can we estimate the total economic impact of serious mental illness? In Table 1 we begin to answer this question, adding the new estimates of income loss to data from 2002 on the direct costs of health care and disability benefits, including Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) cash assistance, food stamps, and public housing financed by federal and state revenues. Missing are the costs of health care for comorbid conditions. Missing are estimates for the loss of productivity due to premature death and the loss of productivity of those with serious mental illness who are institutionalized, incarcerated, or homeless. Missing is the cost of incarceration, although as many as 22% of individuals in jails and prisons have been diagnosed with mental illness (9). Missing is the cost of homelessness, although approximately one third of adult homelessness is associated with serious mental illness (8). And, of course, missing from any such tabulation is the cost to family members who bear much of the emotional and financial burden of these illnesses. The $317 billion estimated economic burden of serious mental illness in Table 1 excludes costs associated with comorbid conditions, incarceration, homelessness, and early mortality, yet this sum is equivalent to more than $1,000/year for every man, woman, and child in the United States.
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