Living With Bipolar

Although this series should probably have been titled “Living With People Living With Bipolar”, I've decided to go with the abbreviated version because I think in a way those of us whose family or loved ones suffer from this disease are also afflicted by it – we suffer too. One summer not long ago I had my first direct personal experience of bipolar disorder. It was not first-hand in that I myself was not diagnosed as suffering from the disease, but the person diagnosed was close enough to me (my younger brother) that I saw a good deal of its affects upon him and learned a great deal, most importantly, about what he needed from me during and after his spectacular and absolutely terrifying psychotic break. Not long afterwards (not remotely long enough), my girlfriend of five years was also diagnosed with this same mental illness after a prolonged depression brought on by the death of an uncle that she was particularly close to, an uncle that had helped raise her and that had, believe it or not, spent decades grappling with his own debilitating form of the very same affliction.

To be absolutely clear: I am not a trained health professional, and at no point should the following be taken as medical advice or anything like it. This is quite simply an effort on my part to describe my own personal experiences living with people suffering from bipolar disorder and my attempts to be there for them in the way that they needed me to be at different points during their own battles with the disease. There are three main reasons I decided to write this: 1) because I think this is an aspect of the conversation around mental health that is inadequately considered or addressed, and 2) because when I found myself having to contend with loved ones suffering from this disease, the psychiatric specialists treating them had little or nothing to say about what I should or could do to help, if I should or could do anything at all for that matter, and 3) because this is a way for me to work through the some of the trauma of the events I'll describe below and a way to attempt to process them and the sometimes painful lessons I've learned along the way.

Bipolar Disorder (also known as Bipolar Mood Disorder, formerly known as Manic Depression) is a blanket term covering what experts call a “spectrum” of disorders and associated symptoms, which can be expressed in an endless number of ways according to the type, severity, and frequency of episodes. While there are quite good rough groupings of these symptoms (mania, hypomania, depressive episodes, etc …), these are expressed in a range of different ways and combinations that can include things like co-morbidity and so-called mixed-states or mixed affective episodes, to complicate things further. There is no standard treatment, in other words, and although there are general rules and commonly accepted approaches, each case is treated on an individual basis because every case is different. The events I will describe are not meant to be correlated with the above symptoms or groupings, and nor should they be used as a diagnostic tool (if you or somebody you know may be showing signs of this or any other mental illness – I recommend you/they seek professional help immediately; this is in fact one of the most important messages I'd like the first part of this story to convey). These are only accounts of things I witnessed, told as accurately as possible. My hope is that in some way this might be useful to someone else who, like me, finds themselves suddenly confronted by some of the difficulties that can arise during the course of a loved one's struggle with this disease – difficulties that can be highly disturbing, hurtful and unbelievably painful to witness or (worse) participate in.

1: The Psychotic Episode – With Vikings References

In December 2013 I was at the end of another academic year, kicking back in great style. My girlfriend (we'll call her Beth) was away visiting her family up North and I was free to do as I pleased. In between gaming, media, and drinking with friends I was moving house and trying to get some work done on my thesis whenever I could. I was at my mom's place one weekend – I think it was a Saturday – when my brother (Doug) arrived with a few of his friends. They'd been to a party the night before and from the looks of them they'd had a really good time. They went to crash in his room and it was back to the quiet lethargy of Saturday afternoon in suburbia for me. Later that day – probably three or four in the afternoon – there was some kind of commotion outside. My brother and his friends were up and about; they were all out in the garden and the friends were leaving. I went out and lit up a smoke, spoke to them as they made their exit, asked them about the night before. I can't remember if one of them said something to me at that point or if I noticed it myself, but something wasn't right. My brother was on edge, confused, rambling. What he was saying to me and to them didn't quite make sense somehow. It was all a bit garbled. I thought he might still be drunk or high, or just badly hungover. I thought he needed some sleep and I remember clearly that he complained about not having slept for a while – for the next week this was something he referred to repeatedly: he hadn't slept, couldn't sleep, desperately needed to sleep.

I told him to go and get some rest and didn't think too much about it. Nor did I tell anyone what was going on – it just didn't seem very serious or too out of the ordinary. My brother was going through a phase at this point where he was living very hard. He'd written off two cars. He was drinking almost every day and was taking a lot of drugs. I don't know what he was taking exactly, aside from smoking a lot of weed, but he was dealing too and always had quite large amounts on him. He had a microwave in his room that he used as a stash (kind of an obvious stash if you ask me, but I still can't resist the obligatory “you can put your weed in there”) and it was always full. He and his friends would sit around in his room playing Xbox and smoking this massive glass bong all day and I'd join them sometimes. The dealing worried me, but I'd been a pothead for a few years by then and I kind of enjoyed getting high with my brother. I knew that a few of these guys had been into meth at one point or another and that worried me too – I'd spoken to Doug about it many times and I was fairly certain he understood the risks of getting involved with that poisonous stuff, but what occurred to me immediately was that he might have taken some; maybe intentionally, maybe not. It would explain the sleep thing anyway. I was worried, but not more worried about him than usual. I went home.

The next morning I got a call from my mom. There was a problem with Doug, she said. He hadn't slept all night and he'd been out patrolling the garden with his crossbow the whole time, firing occasional volleys into the bushes at imaginary burglars with his paint-ball gun, shouting, threatening the tenant with death for stealing a cell-phone at four in the morning (Doug had forgotten it in the tenant's room). I drove over immediately because I could hear that she was distraught and this sounded serious. For the past year or so these calls had been a regular feature of my life: Doug had been in a fight, Doug had been arrested, Doug had crashed his car, Doug was missing. At this point I was getting to the stage where I lived in constant fear of the final permutation, the last call: Doug is dead. This had happened to me before – a phone call in the middle of the night informing my family that my brother had died, not Doug, my other brother, the middle child, my companion from the time I was two years old – and that, combined with Doug's reckless, self-destructive behavior meant that this was far from a remote possibility. I was determined to do everything I could to avoid this happening again, to avoid losing my little brother. With my dad gone (he died in 2009 after a long battle with cancer) and my mom just barely coping, I often found myself stepping in to look after Doug. I felt duty-bound to do so, and I'd been struggling to get him to turn his life around, to cut the crap, for a long time as a result. I was his brother after all.

So I went over, tried to find out what was happening. My mom wasn't much help. She went through the details of the night again and not much else. She'd tried to speak to him but had been met with suspicion, paranoia and open hostility. He thought she was out to get him apparently. I'd soon find out that the list of people he thought were out to get him was a long one, and that I featured prominently. He was trying to get some sleep when I arrived and this was a good thing I thought. While I waited for him to surface I spoke with the tenant. Adam (also not his real name) had a few more details about Friday night's festivities – there had been some kind of altercation apparently, involving a girl somehow. He was short on specifics, but he said he thought there might have been drugs involved. He'd been a speed freak once upon a time and recognized the symptoms of post-binge psychosis. They would pass, he said. We just needed to give Doug some time and he needed to sleep (that word again). Adam was a few years older than me, and a veteran of the seedier side of the city's party scene. He'd won the trust of Doug and his miscreant buddies and so I believed his version of events. I was now fairly convinced that meth had been involved somehow, though Doug to this day denies having taken anything. Adam confirmed my mom's version of the night's strange events – even the bit about a loud banging on his door at four in the morning and a loaded crossbow shoved in his face.

Doug woke up a few hours later, and things began to get really weird. I went in to talk to him, to try and find out what was wrong. He looked haggard, pale and blotchy, and what he said was strange and convoluted. It was very difficult to get any sense out of him at all aside from the fact that something had happened on Friday night, that he felt in some sense betrayed by his friends, that he was concerned I would likewise betray him, and that he desperately needed to sleep, that he hadn't slept the night before or on Friday, and that he was tired and confused as a result. He kept calling me Floki, and then he would switch to calling me Rollo, not drawing any comparisons necessarily, but addressing me as if I actually was one of them. At the time I had watched maybe one or two episodes of Vikings and had no grasp of the plot-lines of the first or second seasons. I didn't actually realize that was what he was talking about and the F in Floki is often quite hard to hear, so I that thought he was making some allusion to the mischievous Norse god Loki. It turned out that he was actually referring to betrayal: In the first season of Vikings, Rollo betrays his brother Ragnar by joining forces with his enemy, jarl Borg. In season two, Floki appears to betray Ragnar by aligning himself with King Horik, though he was later revealed to have just played along in order to lead Horik into a trap. This was, in other words, the thoroughly modern psychosis: it came replete with inter-textual references. I had no idea what to make of all of this other than to try and calm him down and urge him to get some more sleep.

Needless to say, it didn't stop there. For the next few weeks I was referred to as Rollo or Floki more often than not. Betrayal loomed large in Doug's mind, and as the person closest to him during much of this time, I naturally bore the brunt of his suspicion and paranoia. This was hurtful, of course, and unnerving, and his demeanor was often quite frightening. One of the things I found hardest to deal with was the fact that I was never quite sure if he fully understood who I was – I spent many hours trying to explain this to him, to reassure him. I told him again and again that I was on his side and that I was trying to help him. I'll come back to this point. The second thing I want to emphasize here is that Doug is a physically intimidating guy. He is my little brother in name alone; he is many kilograms heavier than me and is built like a brick shithouse. He also has martial arts experience – in Jujitsu and Kung Fu. Never, at any point, no matter how upset or angry he was, did he lay a hand on me or become physical or violent with me in any way. He made threats, of course, but something inside him held him back from physically acting on what he was experiencing, from the anger and aggression he often directed at me, particularly when I attempted to confront him directly. This is obviously not the case with all people in the throes of psychosis (that disclaimer thing again), but as I look back on it I find it strangely comforting. If he'd wanted to he could have hurt me quite badly or worse, but something held him back. I think maybe at some subconscious level he knew who I was all along, that I was his big brother, that I loved him. Whatever the reason, though, I was grateful for it. If he'd become physically violent that would have changed everything.

Forcing myself to remember and reflect on this stuff is cathartic for sure. It is also extremely difficult because I've repressed at lot of it I think. Aside from losing my father and brother, this is the third most traumatic experience of my life so far, and when I try to think back on those first chaotic weeks (before Doug's diagnosis, before, during and just after his period in a psychiatric ward) everything is very murky and mixed up. This first week is particularly difficult – sequences of events are hard to reconstruct, time-lines are tricky. I know that at some point we decided Doug wasn't snapping out of it. The night patrols weren't stopping. His behavior was bizarre. He was convinced he was dying, that he was being hacked, spied on, monitored, controlled, that everyone was out to get him. He harangued passers-by through the garden fence, posted disturbing rants on his social media accounts, harassed, argued with and threatened his friends and family. I lived in fear of the police being called – how would they react to him? How would he respond to them? Would he be shot? Arrested? Locked up? By this stage we were all (my mom, myself and a few of his more sensible friends) quite convinced that he'd ingested methamphetamine, and when his very evident psychosis showed no signs of wearing off, he was taken to an inpatient drug addiction facility – a rehab for hard drug abusers. This obviously wasn't the right thing to do – they weren't equipped to deal with a psychotic man the size of my brother for a start, and psychiatric care is not what they're designed to deliver exactly. He didn't last longer than the morning, and the fact that we'd taken him there only reinforced the sense of betrayal that permeated his current view of the world and the people around him.

This was the point at which we ran out of options. I think it was the family GP who suggested it, though I am not certain. Either way, we finally took him to see a psychiatrist and he was immediately committed to the psychiatric ward at one of the hospitals in the city. His sense of betrayal at this point was unfathomable – he was furious and hurt and confused. He would spend the next two weeks under lock and key in what was, I think, the single most traumatic experience of his own life, surrounded by lunatics (of course I mean other people struggling with mental illnesses of their own - just trying to capture something of what this was like to an uninitiated outsider like myself) and regularly physically restrained and injected with potent tranquilizers. He was prescribed anti-psychotics and mood-stabilizers (and god knows what else). This period was nightmarish and involved a great deal of suffering on his part and the parts of those close to him. We spent as much time with him as we could and did everything possible to make him comfortable and to encourage him to cooperate with the doctors and minders overseeing the ward he was in, to take his medicine and to try to calm down. This ward was hardly ideal and I think it might have done as much harm is it did good. It was dark and dingy and full of some truly terrifying people.

I want to try and get all of this down in the following post, which will chart his time in the ward and the issues and conditions around this period as fully as possible. For now, though, I'm going to have to leave the story here. Doug has been committed. Family distraught. No answers, no information, no word on when he might be released. Horrified ignorance. Tedium. Endlessly walking the same grubby dimly-lit maze-like corridors before and after visits. The feeling that I was failing him, letting him down. Not knowing what to say or do. Trying (and failing) to reason with him. [I really will come back to this point because I think it's quite important, but it will have to be in the next installment.]