Posts Tagged ‘mental illness’

Black Dogs and Guitars

31/08/2014
The Scream by Edvard Munch (1863-1944)

The Scream by Edvard Munch (1863-1944)

Someone once told me I was lucky to have Bipolar Disorder rather than Clinical Depression; they felt that having Bipolar Disorder was easier to cope with because, in their misguided opinion, at least the Depressive episodes experienced with Bipolar would have some light at the end of the tunnel. While that may be true, on the surface, while you are experiencing a depression associated with Bipolar Disorder, or anything else for that matter, it makes little difference if you are fairly certain it is going to end in a day or an hour: for the entire duration of the episode it feels as though you are being dragged through the darkest pit of Hell. The journey cannot end soon enough. The longer the episode lasts the harder it becomes to endure, the landscape of your thoughts take on a bleak, dark tone; all you want to do is hide from the prospect of human contact hide until the pain dissipates, until the light manages to poke its head through the seemingly impenetrable clouds once again.

For the past few weeks the Black Dog of Depression has had its jaws firmly latched its onto me, and I have been on that journey through the pit, albeit against my will. This is not unfamiliar to me, to be sure, but that does not make it any easier to cope with; it just means that I am painfully aware of what is happening to me, as though I were a well prepared roast, watching itself as it is about to be carved up and served to hungry guests for supper, all the while powerless to intervene, to stop the violence about to be done to itself. In many ways a Depressive episode is much like this: it allows a person to see things happening to themselves, but robs them of the ability to act upon what they are seeing, as though their mind has been set in an epoxy or some sort of resin and cannot respond as quickly (or at all) as it normally would. The thinking process is not only painfully slowed down so that it becomes difficult to formulate an intelligent response to someone when they ask you a question (which is one of the reasons I actively avoid speaking to people when I’m in this state), but your comprehension of even the simplest things seems to go flying out the window.

Things, concepts, ideas: that which you had a clear grasp of the day before the Depressive episode began now look to you as alien concepts; they make absolutely no sense. If you do manage to decipher them, having wracked your brain to the point that you’ve triggered your Migraine to the point that it is blinding you, it dawns on you that whatever it is you’re looking at is not what you wanted in the first place, leaving you back at square one, which brings me to my perverse desire to compose while in this state. I say perverse simply because it seems incongruous that creativity should have anything to do with such a bleak, painful episode, and yet, when I am struck by this pernicious illness I turn to creative endeavours as my salvation, knowing from past experiences that these episodes usually result in an increase in my creative output. One might almost describe my output in these times as verging on hypo-manic in nature, and that would be an accurate assessment of the situation were it not for the fact that my mood is in such a depressive state.

schumann2

Robert Schumann (1810-1856)

As I’ve mentioned in previous posts regarding creativity and Bipolar disorder, my creativity is not predicated on an elevated mood, which is a good thing considering how quickly my moods change (as well as how often they change… but that’s another story, for another time). While many people with this disorder have found their greatest creative flow accompanying a period of hypo-mania, such as Robert Schumann who composed in white-heat episodes of creativity and then experienced prolonged episodes of creative silence, I tend to find that my greatest inspiration flows from a mild-depressive state. At least, that’s what I used to think, until this current episode struck. Of the many ways this Depression could be described, “mild” is not one of them. There have been times over the past two weeks when things have seemed desperately hopeless, but … it is a lie.

You have to remember (I have to remember, and I have to remind myself of this every day, every hour, whenever I am experiencing a Depressive episode) that Depression is a profoundly effective liar: Depression will try to convince you that your troubles are far greater than they are, that what you do is not worth anything, that you have no talent, that … well, you get the idea. Depression will use anything it has against you, tossing false evidence against you in an attempt to create its ultimate victory: Despair. Once it has created Despair, once a person has lost all hope of the episode from ending, the battle is virtually lost. The next step is often suicide, and I have seen too many beautiful lives destroyed to allow myself to listen to the whispers of this hoarse demon as it tries to convince me that I have no talent, or that I’m not able to do anything with my abilities as a composer.

In the midst of this Depressive episode, as difficult as it has been to cope with due to the increased pain from the fibromyalgia and Migraine, I managed to complete to compositions for the classical guitar. The first piece is a dark piece, reflective of the mood I was in, though it is not a “depressing” piece. It is called Sonata Apocalyptica, a single movement piece in sonata form, which is about 12 minutes long (perhaps a bit longer, depending on the performer who has a Cadenza to improvise). The second piece, which was completed only last night, on 30 August, is called Perpetual Kaleidoscope and has a Spanish flair to it as it explores two types of the popular guitar technique known as “tremolo” (one is a the traditional three-note tremolo while the other is a two-note tremolo, played pmi using the open “G” string as a drone). This piece is between 7 and 8 minutes in length.

Length is never something that is of particular interest to me, but in this case I find it interesting that in the depths of a severe Depressive episode I managed to compose approximately 20 minutes of music in about 6 days. If there was ever a doubt to the connection between this affective disorder and my creativity, let this put it to rest, once and for all. On several days during this episode, for example, thanks to the nature of the Depression, it was possible for me to sit in one place and compose for almost the entire day. I had almost no interest in food and ignored virtually all interactions with others. When I wasn’t composing I used the music in my mind to drown out the lies of the Depression as it tried to whisper Despair to me in the quiet of the night. Filling my mind with ideas for the piece I was writing pushed aside enough of the blackness for me to get through the time when I was not actually composing.

Now the pieces are completed and the Depression has not (yet) passed, which raises the issue of another type of depression which I have often experienced, a type that often comes at the conclusion of projects: my doctor and I call it “Post Creavit Melancholia”, which may be understood much in the same way as “Post Partum Depression”. The problem is that the Depressive episode from Bipolar Disorder does not differentiate itself from Post Creavit Melancholia (PCM), leaving the individual unaware of what they are experiencing (it would be so much easier if Depression ran an inner dialogue as it tormented you, letting you know the nature of its origins … “Tally Ho! PCM here: good work on that last piece! Sorry to say that I must now make you pay for that bit of inspired work … hope you don’t mind, not that it would matter if you did.”). Suffice it to say, it does not really matter what causes a Depressive episode, what matters is the journey through the darkness: getting through to the other side. Getting through unscathed. Each episode is a war unto itself, each day a battle to be won; ground may be lost from time to time, but it is the overall battle, the ultimate victory over the disease that is important for us to focus on: a Depressive episode will end, we will win the war.

When diagnosing a Depressive episode one of the important elements to consider is the duration of the episode. While a “Clinical Depression” may be defined by a length of at least 2 weeks, the reality of living with Bipolar disorder means you can conceivably experience a Depressive episode that lasts from several days to only a few hours. Size is not an issue when dealing with Depression: if you are attempting to navigate the darkness it does not matter if the journey takes an hour, a day, or a week; for the duration of the journey you are at risk of losing all sense of connection to humanity, all reason to continue living, of falling into the depths of despair, of choosing to end your life rather than persevere through the end of the darkness. This is where it is vitally important to rely on the tools that you have learned along the way to use against the Depressive episode. You may have to fight to remember what you have learned, but it is worth the battle.

As I wrote in my last post, one of the things Depression robs an individual of is perception, but it also steals insight. While you may know something quite well while you are not experiencing a Depressive episode, add the Big D into the mix and suddenly a simple mathematical equation that you could do with your eyes closed feels like Rocket Science … you may as well have been asked to calculate the sixteenth figure in the Fibonacci series (which happens to be 987, in case you were wondering). The point is, when someone is living through a Depressive episode they cannot always see the forest for the trees: they may know that this is something that is going to pass, that it is a temporary situation, but during the episode, during the isolating darkness in which they’re experiencing both physical and mental pain, a mental anguish that can barely be described by any existing vocabulary, it really does feel as though it is going to go on forever … and that is the beginning of Despair. Perception is off-kilter and the lack of insight into how to cope with what is happening to you has to be dealt with on an idea to idea basis: you cannot allow a single negative idea to go by unchecked, you have to pose an intellectual counter offensive against the lies being waged against you, and that is part of what composing does for me. It serves as my personal Cognitive Behavioural Therapy by redirecting my intellectual energy away from the negative thinking towards something positive. It may not end the episodes early, but it helps to keep the darkness at bay, and that allows me to live.

The alternative is unthinkable.

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Burning Brightly Until You Burn Out

13/08/2014

Anyone who knows me knows that I normally do not discuss celebrities, their lives, gossip and the other things that fill the supermarket tabloids. When conversations turn to those topics my blood pressure rises markedly and I either try to change the topic, or drop out of the discussion until there is something worth talking about; the lives of others not being something that I am interested in wasting time discussing. For the most part I try to live my life along the lines of a quote by a former First Lady of the United States of the United States, Eleanor Roosevelt. She said, “great minds discuss ideas; average minds discuss events; small minds discuss people.” The main thrust of this being that there are far more important things that I can, and should be doing rather than wasting my life concerning myself with what someone I’m never going to meet is doing with their life. Sometimes, however, fame intersects with our lives in ways that we cannot help but have a greater connection with than would ordinarily happen, as is the case when someone we admire suddenly dies or is stricken with an illness and suffers terribly, under the watchful eye of the media.
WilliamsandDawber

Such is the case of Robin Williams, a man that many of us were introduced to on a sitcom back in the 1970s called “Happy Days” as “Mork, from Ork”; a role that would become the starring role in the television show “Mork and Mindy” starring his co-star, Pam Dawber. There, for the first time, we were introduced to the manic energy that was – that always shall be – Robin Williams … and we laughed. We laughed, and Robin Williams became a hit, a star … a great success, suffering behind the scenes, when the prying eyes of the cameras were not there to capture the tears of the laughing clown. Pagliacci had taken his curtain call for the final act.

Exeunt Stage Left, pursued by bear.

The recent suicide of comic genius Robin Williams may have as a great shock to many, but it was less of one to others; it is still a tremendous tragedy regardless of which camp you fall into. Like many people, I found out about the death of Williams through a friend of mine on Facebook, but had no idea at the time that he had taken his own life. My first thought, however, knowing that Robin Williams had lived with bipolar disorder for much of his adult life, and had battled severe depressive episodes, as well as addictions, led me to think that there was a very strong likelihood that suicide was going to be the cause of death. Shortly after posting my reply to the original post I read an actual news source referring to the “alleged suicide” and my heart fell; yet another creative genius had fallen victim to the disease of bipolar disorder: the bleakness of depression had robbed them of their joy and they had chosen a permanent solution for what was truly a temporary problem.

Mental illness is not uncommon among creative individuals, and it certainly hasn’t skipped the ranks of the comedic greats, many of whom have battled bipolar disorder, depression, and various other neuroses, which are often what fuels their acts and makes them so enjoyable for the rest of us to watch. The manic energy of Robin Williams gave his comedy an edge that was not seen anywhere else: he would literally walk out onto the stage not knowing what he was going to do until he opened his mouth … and then, magic happened. His brain operated faster than that of the mere mortal, he worked at a level that would astound anyone trying to keep up, so they didn’t try to keep up, they just sat back and allowed the genius that was Robin Williams to wash over them, to overwhelm them with his brilliance, to illuminate them with his wit, and to brighten their lives with what he had to offer … and then … it was over.

But Robin Williams wasn’t alone: others have had similar paths. Richard Jeni, a comedian with a dark, sardonic sense of humour, was also afflicted with bipolar disorder and, unfortunately, took his life in 2007. Lenny Bruce, one of the ground-breakers in modern comedy, died of an acute morphine overdose, on August 3, 1966 after being hounded by the legal system for his use of obscenities in his act (he received a full gubernatorial pardon after his death … I’m sure that made everything better in the eyes of the state). Richard Pryor, John Belushi, Ray Combs, … there are more that could be added to the list, but that’s the point, isn’t it? There are more … there are always going to be more, unless the root problem is dealt with, and even then, there will probably still be more, for the problem is, mental illness may ultimately cause some of us to take our lives, it is also an important component of the creative energy that people want to see. Ah, yes … therein lies the rub. If you take away the pain, if you cure the blackness of the depressions, do you steal away the creative energy as well?

Bipolar disorder was also known as Manic Depressive Disorder because of the nature of the illness. Aristotle wrote that the element of Mania (described as “hyperthymia”) as being responsible for the heightened mental gifts of artists, writers, poets, and all creative minds of the time. Given the number of highly talented individuals who are perfectly healthy and lead well balanced lives we know that it is not necessary to have a mental illness to be creative. However, researchers have demonstrated that given the relatively small size of creative communities compared to individuals who consider themselves to be non-creative, affective disorders such as depression and bipolar disorder occur at much higher rates than they do throughout the non-creative population. This is demonstrated in the writings of Kay Redfield Jamison, who is both a Clinical Psychologist and Professor of Psychiatry at Johns Hopkins University School of Medicine, and an author of several books including Touched With Fire, in which she examines the world of creativity and mental illness. Jamison shows clear connections between the creative worlds of composers and writers and that of bipolar disorder and depression. As someone living with bipolar disorder I cannot help but see those same connections between these comedians, many of whom have also been diagnosed either with bipolar disorder or with depression, and their work. As much as someone with this illness may despise it, a realization emerges that it is also what feeds our creative life (or at least it is part of that process, a part that cannot be separated from the whole): we either develop a grudging respect for the illness or a respectful fear for it, but we never become pleased to see it; there is never a time when we are buddy-buddy with the mental illness in our lives.

WilliamsSadThe problem arises when we grow complacent about the illness. Mental illnesses can kill, as we sadly saw with the tragic passing of Robin Williams, but they do not have to: they can, and should be managed, but this is where things get difficult for those of us who rely on that creative energy that flows from the fires of the mental illness … fires that can burn too bright … fires that can burn us, engulf us … kill us. The fires of creativity, for some, come out of manic episodes, which is extraordinarily dangerous as full-blown mania can be absolutely out of control: they are usually accompanied by symptoms such as grandiose thinking, making great plans and not finishing any of them, working without the need for sleep for days on end, fast talking, loss of emotional control, lowered inhibitions, sexual promiscuity, risk taking, and being easily distracted (among several others). Full-blown mania usually results in the individual ending up in the hospital, receiving heavy sedation until the episode finally breaks. People have actually died from manic episodes as a result from an acute lack of sleep as the disease can cause people to remain awake for more than 72 hours, after which the person can literally die of exhaustion. Unfortunately, this is not necessarily the most productive type of energy that one can work under, for fairly obvious reasons. If you cannot stay still long enough to write down the idea that has popped into your mind it really isn’t that much use to you to have been inspired in the first place.

There is, on the other hand, a sub-type of bipolar disorder that is much more conducive to creativity than full blown mania, which occurs in Bipolar type I, and that is Bipolar type II, which is defined by someone having experienced an episode of hypo-mania. Unlike full-blown mania, hypo-mania is not as severe, not as reckless in its severity, and the person afflicted with it is not as likely to end up in the hospital as the result of the episode. This is the type of Bipolar disorder that I’ve been living with for about twenty years, and I couldn’t imagine living without it, even though it has sometimes made me want to die, for I know my creative life is inexorably tied to the cycles that I experience. The energy that comes from the cycles is something that I am able to channel into my work on a daily basis, but the true hypo-manic episode is fairly rare … and that is by design: if they were allowed to appear more frequently the extreme depressive episodes would appear more frequently as well. Thanks to the treatment that I receive my episodes are reduced, but the creative energy is still present, and that is something that I wish someone like Robin Williams could have found for himself.

I’m not ashamed to say that I see a psychiatrist. I’ve been seeing him since I began treatment for depression, back in 1999. I was improperly diagnosed as having unipolar depression at first, which isn’t uncommon when it comes to this illness; it often takes 10 years to properly diagnose bipolar disorder. Consider this: people with bipolar disorder don’t usually go to their doctor when they are felling “up” or manic, they go when they feel down in the dumps, depressed. The doctors see the symptoms of depression, ask a few questions and diagnose a depressive illness: but that’s only half of the picture. Antidepressants can often send the person with bipolar disorder into a faster ride on the Roller-coaster-from-hell, so much so that many psychiatrists do not prescribe antidepressants at all for patients with bipolar disorder, even when they are in a depressive phase of the illness. The medications used to treat bipolar II are varied, but it has been found that a cocktail of novel antiepileptics and second generation antipsychotics (several of which also have antidepressant properties) are sufficient in balancing out an individuals mood.

When I see my psychiatrist the first thing he asks me is “how is your writing”? He knows that the best predictor for my mental health is how I’ve been working over the past month. If I’ve been composing and/or writing: I’m doing well. If not: Danger Will Robinson, Danger! I can take a day or two off every now and then, and that’s fine, but if I go a week without writing … that’s not good. If I went a month: that would be a MASSIVE call for help, and I might not have even seen it myself until I brought it up at appointment. The point is, I am very much about what I do: I am a composer because I compose. It is what I do, it is who I am. Similarly, I am a writer because it is what I do (when I have time, usually if I’m not composing). I’d love to take the time to sit down and work on my novel, but I have too many pieces I have to compose … so … I have to work out some sort of compromise (I still have to figure out how to not sleep at all … I’m working on it … a future post, perhaps).

The important thing about seeing my psychiatrist is that we’ve developed a great rapport and, more than anything, he understands the importance of my work in my life. It would be possible to completely eradicate the bothersome symptoms associated with the bipolar disorder in my life: all that would take would be more medication. When I began my treatment, in 1999, we tried doing just that, but the problem was it stopped me from being me: I couldn’t hear music. The music in my head stopped playing and I couldn’t stand to hear it at all … I didn’t want to live, and didn’t want to take that medication. Surprisingly, my doctor understood, and a new protocol was established. Lower doses of a different medication (after some experimenting), and we arrived at my present “cocktail” of three medications: two mood stabilizers (two antiepileptics) and an extremely low dose of a second generation antipsychotic, which serves as a “major tranquillizer” to “quiet the monkey chatter” in my head at night. It works. Well. But, it doesn’t stop my moods from cycling, it just rounds off the sharpness off the corners so that it doesn’t hurt as much when I bump into them.

To say that depression doesn’t still affect me would be a lie, it does; it visits far more than I’d like, but the episodes do not last nearly as long as they did before I began treatment. What used to last weeks or months now last hours or days, though they can be just as severe and dark. Fortunately, I was also able to participate in a program of psychiatric rehabilitation at the Royal Ottawa Hospital, here in Ottawa, that provided me with an abundance of tools for dealing with my depressive episodes from Cognitive Behavioural Therapy to Symptom Self Management. I can’t help but wonder how those groups might have assisted a person like Robin Williams to learn some valuable tools to help him cope with his inner demons. Of course, a few years ago a dear friend of mine from high school also lost her battle with depression and chose to end her life, chose to solve a temporary problem with a permanent solution. She left this world on December 6, 2006, and it shocks me that it was so many years ago … the pain of being notified of her death stings me to this day … I don’t know if anyone would go through with suicide if they really knew how much pain it would cause those who would be notified of their deaths.

Let’s be straight here: I did not know Robin Williams, but felt as though I did through his work. A dear friend of mine, however, did commit suicide, and I still feel the pain of her death. I still hurt when I think of the things I’d love to share with her … and I still have her email address in my contact list, and her phone number in my (new) phone. She took her life almost eight years ago, but it feels like yesterday, and when I think about how senseless her death was, how much life she had in her, it grieves me tremendously, but I know that she was in a great deal of pain because of the depression that she suffered from and also because of a chronic pain condition called fibromyalgia. When you think of the emotional distress that Robin Williams was experiencing over the last few months the difficult thing to ask is why he didn’t seek help. A man with his resources could have certainly accessed any mental health services in the United States, and yet, he seemingly chose to suffer in silence and die alone.

Mental illness can be a terrifyingly isolating disease to suffer with, especially when you think you’re going through it alone, and people living in the public eye may not feel it is so easy to access the same services that everyone else is able to when they aren’t being watched by the paparazzi 24 hours a day. At the same time, I find it difficult to imagine someone of William’s personality sitting in a room full of people trying to get help for his mental illness … but that’s the point, in seeking help you have to be just that, an ordinary, average person. When I sat through my groups in the hospital I wasn’t there as a composer or writer, I was there as a person with an illness, seeking their expertise: I NEEDED their help, and I received it. The great irony, I suppose, is that when he needed the help of others the most, when in his darkest hour, that’s when Robin Williams should have relied on his fame to get himself the help he needed; instead, alas, he listened to the darkness. I will always remember Robin Williams for the light that he brought into this world, for the laughter that he gave us, and the tears … the tears of joy. But I will also cherish the darker Robin, the Robin Williams of One Hour Photo, in which he did not play for the laughs, he instead explored a darker side of life; we know understand, all too well, that he was well acquainted with the darker side of life.WilliamsGlad

Everything that I’ve heard since his death has painted a picture of a man who was exceeding generous and kind, both professionally and personally; Robin Williams was not only funny, he was a genuinely amazing person both on and off the screen, and that is good to know. It is always heartbreaking to hear that someone you admired in life turned out to be a selfish jerk once they’ve died and everyone starts talking about them. This is why I do not write about celebrities ordinarily, or gossip, as a rule. I only chose to write about Robin Williams and his suicide as a vehicle to discuss the issue of mental illness, in the hopes that it might help others who happen to find themselves in a desperate state, others thinking of hurting themselves.

Please: suicide is not a way out, it is not a solution. Depression is not a permanent state of affairs, depression ends: it always does. Sometimes it seems like it goes on forever, but trust me, it WILL END! Please: if you are feeling suicidal contact 911 or the Suicide Prevention Hotline (America / Canada) or, if you have one, call your doctor. They are not there to judge you, they are there to help you, and they will.

Carpe Diem.

No, what’s YOUR problem?

17/06/2010

Stigma by the Numbers
People with mental illnesses face many battles as they try to cope with the various illnesses trying to take over their lives, not the least of these is the stigma of having to live with something that they have absolutely no control over. Think about how unfair it is to be judged for something that you have nothing to do with: it’s like being called a bad person by virtue of your skin colour or your sex. While we obviously try to not tolerate these prejudices in an ‘enlightened’ society, they nevertheless continue to take place every day. People with mental illnesses face the harsh judgements of people who have medieval understandings of the realities of the illnesses and their treatments.

We see this lack of knowledge when we hear people speak so carelessly about mental illness: how someone is ‘depressed’ because their team lost, or someone has a ‘split-personality’ and must be schizophrenic. What they don’t realize is that true depression is a serious illness that can, if left untreated, lead to death, and that schizophrenia has absolutely nothing to do with ‘split personalities’; that is a myth perpetuated by bad movies and an ill-informed media.How Misunderstood Mental Illness is in America

When dealing with issues such as suicidal ideation or serious suicidal states it must be made clear that these acts are not done merely to attract the attention of others. When someone only wants the attention of others they will ‘grandstand’, declaring their intentions in such a way as to attract that attention, usually before an actual or serious attempt is made. However, an attempt at suicide, regardless of whether it fails or not, is a call for help that should never be ignored.

Stigma can only be defeated when we answer ignorance with reason, demonstrating that people with mental illnesses have as much to contribute to society as anyone else.