XPLANATORY NOTE ON MY MANIC-DEPRESSIVE ILLNESS
The following piece was written for a secular government institution. I have no doubt that prayer, religious scripture, my belief in God and the meaning system I derive from that belief have been an invaluable source of help to me, but they were not mentioned in the following statement. At the same time, were it not for chemotherapy and the lithium and fluxoxamine that I was given by psychiatrists, I seriously doubt if all the religion, pop-psychology and TLC would have been any use at all. Values and beliefs went hand-in-hand with mainstream psychiatry and the tools of chemotherapy. But without the latter, I have serious doubts of the value of the former.
1. I would like, in the following, to outline my experience both long-term and in recent years with manic-depressive illness to provide interested readers, my G.P. and any government body assessing my illness with an adequate information base for their varied and specific purposes. In this case the information is intended to help evaluate my application for continuance on the Disability Services Pension at the age of 60. More recently I have come to see this experience as my personal ‘horror story’ and from time to time I submit it as such at various sites on the internet or to other parties for other reasons. This statement may be a little too clinical for some readers; it may be lacking in pizzaz-adventure-and-excitement for others, but it contains its own degree of very real horror--the only horror that I have tasted in life. This is no fantasy creation to stimulate middle class readers and help them find an avenue for escape into print.
2. After half a dozen episodes, varying in length from several days to several months, of manic-depressive illness between 1963 and 1980, I was treated with lithium carbonate in Launceston by a German or Austrian psychiatrist, a Dr. Glinka. I have been on lithium now for twenty four years. My mood swings, now in 2004, take place, for the most part, at night with the death wish still part of the experience. The symptoms that affect my daily working capacity are fatigue and psychological weariness, especially after a night of light sleeping, tossing and turning and the resulting feeling that I have not slept at all. Dryness of the mouth and short term memory loss also seem to affect my daily life now after 40 years of the onset of this disorder. Perhaps these symptoms are a result of the eight ECT treatments I had as far back as late 1968. Feel free to contact my psychiatrist, Dr. Eric Ratcliffe, in Launceston or my G.P. Dr. Jane Zimmerman, for more details and a professional assessment. I have discussed my case with Drs. Ratcliffe and Zimmerman for four years and they would both be happy to discuss my case should you want any clarification and elaboration of the issues and medical assessments involved. I have no trouble being quite transparent about my case since I am not looking for a job any more.
It seemed appropriate to provide some detailed statement, a statement that expands on the information provided on official government forms or the casual off-the-cuff descriptions that I give to friends occasionally. Since the issue of this bi-polar illness is a complex one, varies from person to person and has come up many times over the more than forty years that I have had to deal with its symptoms in my working life, I write what follows from a perspective of "40 years on..." It is difficult to characterize, to summarize, my condition, but it is useful to try. I hope the account below may be of use to anyone assessing my application for a Disability Services Pension or simply wanting a more detailed description of my experience with what is now called a bi-polar disorder.
1. Process 1:
There seems to be a process, one that I experience on a daily basis even now in which I cross from normal behaviour to some abnormal extreme. I would call the present behaviour symptom a tedium vitae, a fatigue with life feeling. It only occurs after midnight. Due to this "process" over the last forty years in a much more accentuated form until 1990, it has been difficult to define just where I was at any one time along that 'normal-abnormal' continuum. This was true at both the depressive end and the hypomanic end of the spectrum. It is difficult, therefore, to actually name the number of times when I have had major manic-depressive episodes, perhaps as many as eight, certainly as few as four, in my whole life, until the last brief episode in 1990 when I went off my lithium for between one and three months.
At the hypomanic end there were experiences like the following: "violent emotional instability and oscillation", "abrupt changes" and "a sudden change in a large number of intellectual assumptions."1 Mental balance, a psychological coherence between intellect and emotion and a rational reaction to the outside world all seemed to blow away, over a few hours or a few days, as I was plunged in a sea of what could be variously described as: emotional heat, intense awareness, sensitivity, sleeplessness, voluble talking, racing mental activity, fear, excessive and clearly irrational paranoia--and in 1968 virtually total incoherence at times--at one end of the spectrum; or intense depression, melancholia, an inner sense of despair and a desire to commit suicide at the other end. The latter I experienced from 1963 to 1965, off and on; the former from 1964 to 1990, on several occasions.
2. Process 2:
The longest depression was in 1963 and 1964 with perhaps two six month periods from June to November and July to December, respectively. The longest episode of hypomania was from June to November 1968. The hypomania in 1978, 1979, 1980 and 1990 were treated quickly with medication, although the 1978 episode, beginning in January, seemed to last for at least three or four months and had a mostly depressive component. I had no experience of this variously characterized illness in childhood. It was not until I was 19 that any characteristics of this illness became apparent in my day-to-day life. My episodes seemed to be quite separate tendencies; hypomania often lead to depression and vice versa. In the 1978 episode, elation and depression followed each other within a two to three month period. Clearly, in the episodes in the late '70s, fear, paranoia and the extremes of depression seemed to be much less than those of the 1960s.
There are a variety of manic-depressive profiles, different typicalities. It is bipolar because both ends of the spectrum, the mood swings, were experienced over the period 1963 to 1990, twenty-seven years. Thanks to lithium the extremes were treated by the time I was 36 years of age. It took another ten years for me to fully accept the lithium treatment. From time to time I tried to live without the lithium. Such, in as brief a way as possible, is the summary of my experience over the years. The account thusfar has none of the fine detail that I could include like: mental hallucinations, specific fears and paranoias, electroconvulsive therapy, psychiatric analysis and diagnosis, experiences in and out of several hospitals with a great number of people, situations and, looking back, humorous and absurd events. I would like, now, to focus on my more recent experience of the last several years.
C. Short-term 2002-2004:
In 2002 Dr. Eric Ratcliffe, my supervising psychiatrist in Launceston, suggested I go onto fluvoxamine in addition to the lithium treatment. Fluvoxamine is an anti-depressant. The fluvoxamine removed the blacknesses I had continued to experience at night, from about midnight until, say 7 or 9 am. The death-wish has always been associated with these blacknesses. With the fluvoxamine, gradually the blacknesses, the depressions, disappeared. The death wish remained, although the dark and debilitating feelings were at last removed. Only the tedium vitae remained. After forty-two years of periodic bi-polar disorder, the worst symptoms seem, at last, to have been treated.
D. Concluding Statement:
This brief and general account summarizes both the long history of this illness and where I am at present in what has been a life-long battle. I think it is important to state, in conclusion, that I possess a clinical disorder, a bio-chemical, perhaps even an electro-chemical, imbalance, still only partially understood by medicine, having to do with brain chemistry. Two to three percent of the population suffer from this illness and, for me, the extreme symptoms are now virtually treated by lithium carbonate and fluvoxamine with a residue of symptoms remaining which I have described briefly above.
The main problem now, in 2004, within the constellation of the residual symptoms associated with this bi-polar disorder, is getting to sleep and staying asleep. I often do not get to sleep until 2 am or after. I then wake up to urinate at least twice before I get up in the morning. Getting back to sleep each time is an aspect of this problem. So it is that by morning I am often exhausted, fatigued, worn-to-a-frazzle, having slept little and lightly. If, of course, I can sleep in until 9 to 11 am I am okay. I am certainly in no condition to go to a job, a place of employment to do full or part-time hours unless the hours were adjusted to my condition. And the nightly death wish, as I'm sure you can appreciate, is certainly not conducive to my overall psychological health and employability, although I do not want to overemphasize this. I really do not find it a problem; after so many years it is like an old friend.
In five years I will be 65 and will go on the Australian Pension. I have not worked in full time employment for the last five years. I would like to remain on this Disability Services Pension that I have been on now for two years(5/'02 to 5/'04). Although I have been treated for the worst side-affects of manic-depressive illness, I have little energy or enthusiasm for what would be five years of employment before full-retirement(the next DSS Review of my case is in 2007). My short-term memory loss often feels like the beginning of a dementia condition, although I had a memory test administered in 2001 at the Medical Services clinic in George Town and it did not indicate dementia. My wife, though, who knows me well and experiences the affects of this memory loss in our domestic arrangements has been very concerned for my health and well-being for several years now.
If you want to draw on the opinion of my wife, my G.P. and/or my psychiatrist, I am confident they each will provide opinions, medical and personal, to support the evidence I have provided in this written statement. In 2004 I was granted a part-pension by the Canadian government and in 2009 I will receive the Australian Pension. After a lifetime of struggling with this bi-polar disorder and several years now on the Disability Services Pension, it is my view that it would be unwise for me to be taken off the list of people with an official disability. In the few years remaining until my formal retirement onto the old-age pension here in Tasmania in 2009 it is my view that I should remain on this Disability Pension.
I hope the above provides, with any required formal application and the statements of doctors,' friends and/or relatives, a sufficient information base for you to get an accurate picture of my disability and then to make any assessment of my condition that is required.