Cognitive Therapy and Bipolar Disorder - News #1

I have decided to begin noting news items that I find helpful or interesting – so this is the first. Researchers in Britain, from the institute of Psychiatry in London have completed a study, which shows that patients with bipolar disorder who are given cognitive therapy added to mood stabilizing drugs, are less likely to have relapses. The study also looked at how the combination therapy was more cost effective, by cutting down on the expense that relapses incurred. The full study was published in the British Journal of Psychiatry
http://bjp.rcpsych.org/cgi/content/abstract/186/6/500

18# Pulling Away From the World

That night I asked David how his day at school had went and he told me it was OK. But as the evening preceded he began to share some concerns - he worried that he wouldn't be able to catch up and he didn't understand some of the things that were being discussed since he had missed so many days - I assured him that it would be easy for him to get caught up - but a nagging doubt begin to gnaw at me - David was a genius - he had never had any trouble understanding anything at school and had been able to pick up on complex concepts by just perusing the text - what could be wrong? What if the overdose had caused some brain damage? Maybe it was the medicine that was affecting his concentration? What I didn't know then that I have since learned is that some forms of mental illness can affect the way ideas are organized in the brain and thus can make learning difficult - then I only knew that my son was very worried and considering his past suicide attempt this was unsettling - the next day we went to the councilor for the first time - I was very pleased with him and David appeared to like him - in session David opened up a bit more about school and admitted that it wasn't just the work that had him concerned - he was extremely anxious while there and again felt like everyone was staring at him - he said he didn't want to go back - I thought that this would be a mistake - you know the old saying about getting back up on the horse - but to my surprise the councilor agreed with him - he thought that it would be a mistake to force him to be in a stressful, anxious situation so soon after his attempt - alone he told me that sometimes it took six months to a year to get back to normal life - another reminder of how our life had changed! I agreed to call the school and see if they could set up home instruction for David, at least for a couple of months. To Be Cont.

17# Snow Storm

The first day David went back to school snow was threatening – gray clouds hung low and heavy as I drove the kids to school. The weather fit my mood of foreboding – all day I worried about my son – how would he answer all the questions – the principal had sent out the story that he had a bad flu and had spent some time in the hospital. I worried that he wouldn’t be able to handle the stress, the stares, the whispers. But when I went to pick them up after school all my fears seemed to be allied. David was smiling and asked if he could run to his friend’s house for a sec and then his friend would bring him home – glancing at the still gray sky and the first few snowflakes – I reluctantly agreed – I didn’t want to seem overprotective and thus embarrass him – OK – but be careful and hurry it looks like its finally going to snow. By the time the rest of us reached home the flurries had turned into a snow squall and the police scanner (my husband’s nosy hobby) was calling for ambulances, rescue, and cops in every direction. We had just missed several wrecks on our road – I immediately started to panic – why did I let him go? I called his friend’s house – they had already left – after I had paced for a good half an hour my daughters suggested that we drive as far as we could and then try to walk up to the wrecks since they had shut down the road – and so we did - we had to walk a good half mile in the wind and snow to get to the first crash and of course – they had just towed off the car and opened the road – it wasn’t my son’s friend – they had just been stuck in traffic - trudging back to the car my fifteen year old daughter said “you wouldn’t have done this for any of us – you would have trusted that we were all right and would get home as soon as we could” I didn’t answer because I knew she was right – I didn’t know how to explain or for that matter stop the emotions that were simmering inside waiting at any minute to come spilling out – primal motherhood – an overwhelming sense of needing to protect my son and a terrible fear that in the end I would be unable to – To be cont.

16# Sleepless in Ohio

First off sorry about the long time since the last post - I took a well needed break - now back to the story - that first evening home David was ecstatic - he was so happy to be back in his room with his games and his i-pod - and with us. I was proud of the other kids in that they greeted him as if he had just been on any extended trip - I wish I could say the same - it was as if I had just brought him home as an infant - I couldn't sleep - I kept creeping downstairs to check on him hoping that he wouldn't catch me being an extremely over protective mom - but each time I lay down to sleep, the night that I found him kept playing over and over and then up I crept again. I was exhausted the next day but joyous that I had my son home - and with everyone else up I could relax - and so it went on for days - as soon as I would drift off to sleep I would have nightmares all involving David - always I was deperately trying to save him from some unknown enemy. This insomnia has slowly eleviated - almost six months later I sleep much sounder, but if David has had a bad day or we've had some upset (more on these matters later) again I find myself creeping down those stairs -

15# Home Again, Home Again

Jiggidy, Jig - when the kids were little I always repeated that last line of the nursery rhyme when we pulled into the driveway - It was Wednesday when David came home exactly a week since he had been admitted - it seemed much longer. My mom and I drove up that evening to get him and found him happy, but nervous waiting with all his things in a trash bag and a handful of projects that he had completed in Art therapy - He had one braided and beaded necklace that one of the girls had given to him. The girl walked over shyly to say goodbye - beautiful girl rail thin - anerexia I thought to myself. And then we were on our way home - Mom asked if he wanted to stop and go in to to eat - he declined - so nervous - he talked on and on about the medicine and the ward - none of us knew how to act - I could never have imagined that I would ever feel so uncomfortable with my own son. He was very upset that they had not given him any medicine for evening - "I have to have it Mom; they said that even one dose missed could be bad." Hearing the panic rising Mom, as usually was the calming force - "Don't worry we'll find a pharmacy open - and we did find it - when we parked David said he had to get some air for a minute - as he paced around the parking lot - I felt like crying - "Who was this person I was taking home?" How was I supposed to react - what was I supposed to say - what behavior was normal for him now? Nothing in my past had prepared me for this - I looked over and Mom seemed at ease - just as if her grandson, once brilliant and self possessed was now pacing around outside agitated and different, oh so different. Well, I thought if she can remain calm so can I - I tried to focus on the positive - at least he was here - at least he was outside pacing - we hadn't lost him - that did help - by the time he got back in and he took his medicine, rispardal, I was feeling much calmer - when we pulled into the driveway that old line spontaneously came out "home again, home again." David smiled ear to ear. "Oh, I've missed it so much." to be cont.

A Quick Note and Man's Best Friend

A Quick note - I just posted a review on the resource page of a wonderful memoir

Man's Best Friend - this post is just to honor all loyal dogs everywhere by testifying about our lab, Bernie. He's seven years old and an inside dog. In all those years, every night he slept outside of our bedroom. That is until the day I brought David back from the hospital, since then he has insisted in sleeping in David's room. If we try to shut him out he barks, and whines till David finally gives in and opens the door. Its as if somehow the dog knows that David needs protection in some way and he is determined to keep an eye on him - it actually helps me go to sleep at night knowing that Bernie is on guard. So thank you Bernie and all man's best friends; I now know how true that phrase is.

14# It's You and Me Against the World

The break gave me time to recharge a bit and I thought I was ready to take back up the load the next morning. The day started well; David called and was very excited because they had told him he would be going home the following day. I said this was great and that I would see him that evening, but in my mind a hundred things began to flit around. I tried to pin one down: I needed to get his room finished - clean floor - make the bed up with new bedding - we needed to put up the hunting rifle - where should we take it - the pills - where would I keep the pills. My mind was busied with a list of things that must be accomplished before he came home - and so I managed to push out a rising panic about his homecoming. But slowly as the busy day passed something began to take over - a rising river of fear inch by inch began to seep into my awareness. The fear felt primitive and overwhelming - it urged me to run - to run fast, far, far away. It wasn't till the drive home from the hospital that evening that I realized what I so feared - it was the crushing responsibility of caring for a possibly suicidal son - Half of me wanted nothing more than to have him safe under our roof - to have that comforting physical proximity - but would he be safe? And if he wasn't whose fault would that be? And I knew right then how much my life, not only my son's had been altered irreparably - for a could not fool myself into believing that anyone else, not even my husband, who was himself on mental thin ice, could or would carry this burden. It was like bringing home that first fragile infant and knowing that whatever may come, when you boiled it down to the core; I could look at this fellow human whose fate is primarily, with God's help, in my hands and say, well it's you and me against the world, kid. To Be Cont.

13# The Light, the Vent, and the Rock

You know I have always believed in mother's intuition; it probably saved my son that fated night in January and I'm sure it often lead my mom to call me when I most needed it. She did so on that day, as I waded around in a mire of faded anger, hopelessness, and growing apathy. When I explained what had occurred on the phone, she paused and then as always came up with just the right words. Well you know, you are his vent; he needs someone that he can share these tough emotions with and obviously he is not opening up to the staff up there. He trusts you and knows that you will love him no matter what he says; you are his vent. But I would say that it would be good for you to take a break today - you do not want to break down in front of him - why don't you see if Nicole (name changed for privacy) could take the other kids with her to visit tonight. Feeling much better I got off the phone and decided it would be good to take an evening off; I called my oldest daughter and she agreed to make the trip herself. After work I sat with my husband trying to relax; I knew that I had to let myself heal a bit so that I could help David (name changed for privacy) - but I spent most of the time jumping to get the phone every time it rang - afraid that something would be wrong - I shouldn't have worried - the kids took him a large meal from Taco Bell and they had a great visit - a lesson all caregivers need to learn is that it is OK to let someone else help - you not only can, but need to give yourself time to recharge - that night as I lay in bed sleepless, as I had been for a week - I suddenly laughed - actually laughed - the first time since the suicide attempt - my husband rolled over and asked me what was so funny - "It's just that Mom the other day said that I had to be the light in the dark - then my aunt said that I was certainly the rock that the family depended on, and just today Mom said I had to be David's vent - I was thinking it sure is hard to be the Light, the Rock, and the Vent - I wonder if I could hire someone to take over the position" My husband looked as if I too was losing it - "I don't think so" - "No, I suppose not" I sighed "The problem would be getting anyone to apply!" To be cont.

Important Additions

Sorry its been so long since I posted, but I have been working on some exciting changes to the blog - I am adding two new pages - one about resources: books, movies, websites, etc. - the other dealing with news - you can access the pages through the links to the right - I have added the Resources link today and will add the News link soon - I hope you enjoy the new additions!

12# Shattered Glass

Morning brought a new prospective - I felt my energy creeping back and I was able to at least plan for the day. After work my daughter was going to drive me up to the hospital and until then I tried to concentrate on getting prepared for class - I had been sleepwalking through my classes the week before so I felt that I had better get my act together. Then the phone call came in - it was my son, obviously tremendously agitated - "mom, get my out of here - right now - I mean it - I'm not going to any more of their stupid group sessions" - I attempted to calm him down - "it will only be for a bit longer - the more you cooperate the faster you will get out - remember you are there to get help." His voice rose in decibal "help - this place isn't helping me - it is making me crazy - mom, please come get me!" By now I had started crying, but I didn't want him to know "I can't do that son, you must stay till they say you are better" - then he really lost it "you won't get me out of here - well then I'll find a way to kill myself - I'll throw myself out the window - I'll smother myself with the pillow" Something about this hit me like a full slap to the face - I geuss I had a lot of anger, as well as sadness in me and it came bursting out, cascading down into the phone and across the miles - it was boiling water, rolling and frothing "you're not the only one who could kill themselves and I have many more implements here" - it was out before I could take it back - why did I say that - why was it up to me to deal with this - I gripped the phone till my hand hurt - he hung up and I sat there in a fit I can't adequately describe - it all felt so unfair - why? why? I sobbed - I had the terrible desire to grab a bat and break every window out of the house howling out the pain and the anguish - if I couldn't break something I was sure I would break - instead I sat alone racked with sobs, pouring out my fury in sound instead of action - I finally relaxed my death grip on the phone and hung it up - immediately it rang "mom, I'm sorry - could you bring up my acne medicine and Arby's" - I got out ok and he hung up - I was left shaking and weak - drained of the anger, but also all energy and will - it didn't make sense "how could someone say they were going to kill themselves and then the next minute be worried about their acne and food - I myself felt that I would not ever want to eat again - and I knew that somehow I had to drag myself up and go to class. To be cont.

11# Rolling Waters

I should have woke up the next day feeling great - after all I had made progress the day before and my son had seemed better - but for some reason that Sunday I arose flat - I felt drained and useless - I felt ashamed, but I really didn't want to go back to the hospital - of course, I made myself get ready - and as I showered I cried - but this time they were selfish tears - I wept for myself, for a life that had been torn assunder, all the usual daily tasks thrown to the wind. Some Sunday's I did get up and go to church - most Sunday's I fixed a big meal and spent the day resting and grading papers, preparing for the week ahead - perhaps of all other days of the week it was Sunday that was the most predictable for me - and so I suppose that is why I felt so down -and it was still raining - the downpour had decreased to a drizzle - but that did not nothing to alleviate the gloom outside or in my soul - My mom drove me up again and no doubt noticing my depression she tried to bring me back up - she is the best at bringing a positive viewpoint - at being that light in the dark - but perhaps I needed for one day just to let myself feel miserable for myself, for my changed life and my awareness of a new crushing responsiblity that would descend upon me the day my son walked out of that ward. I tried to put on a false cheery face during the visit so I wouldn't bring my son down and it did seem to work - he was very entranced with the new medicine rispardal and how it made him dream strange dreams - dreams that he couldn't quite seperate from real memory - I suggested that perhaps they should increase the dose again - it seemed somewhat dangerous to not be able to sort out in one's mind what is a dream and what is real. Numb and distant, I managed to get through - I hugged him at the end - almost breaking down - this was so unfair for him - for me - for everyone - why was it that my son was in a psychiatric ward - I must have failed - I held him tight and in my mind whispered "I'm sorry" - In a daze I walked to the car - "No, I didn't want to go in anywhere to eat" On the way home my tears dribbled out like the rain drizzled outside - I didn't have energy for a downpour. The rivers were going down a bit, but were still flooded - as we drove over one - I stared at the rolling, nuddy water and had the strange sensation of falling, of cold water pulling me ever on, drowning my sorrows and pain - so easy it would be - just to let go. For the first time I understood in a way my son's decision that night - some pain is unbearable - it can seem much easier to let life slide away and fall into those drowning, rolling waters. To be cont.

10# Connection!

We went shopping between the visiting hours for my son some new bedding - my plan was to spruce up his room before he got home to further cheer him up and hopefully help him start fresh - we found him a nice duvet set and sheets in black red and gray to match his favorite possession, his i-pod. After picking him up another huge dinner I went in for the evening visit - he wasn't waiting so I walked to his room - he was meeting one of the staff members and although I felt a bit guilty I couldn't help pausing outside for a moment - my son was explaining that he had been working in his book and that the risperdal did seem to be working but that he had heard a strange conversation while taking a shower - the conversation consisted of two men discussing the fact that another man had fallen off a ship - the staff member did not comment and feeling worse now for evesdropping I went to sit down in the lounge till the man came out - my son seemed very happy to see me and the massive amount of Mexican food, his favorite - I asked casually how the rest of his day had been and he surprised me in two ways - first he repeated the story about the voices - I assured him that when they increased the dose of risperdal, which they were going to do that evening the voices would probably go away - of course I was winging it here - this was all new territory - then he showed me the journal - in it he had added a poem to match mine - of all the literature and poetry I have read and treasured through my life this simple poem was more beautiful to me than it all - for it represented a connection back to my son - in it he spoke of the pain of being stuck in the hospital and how he wanted to be back with home with his family and friends and most importantly how he knew that I was there for him - I tried to hold back the tears - this time from happiness and the rest of the visit went well. To Be Cont.

9# Just Before Dawn

The next morning I awoke shaky, weak, and determined. I thought about my son's words the night before "this is my life now" - though I could not, would not let myself believe the hopelessness of that phrase I did know that life as we had known it had changed forever. Instead of spending the rest of my time crying and in despair I had to find a way to cope and to improve the situation the best I could. I had to somehow find a way to connect with my son, to comfort him and let him know that my love had never wavered - I remembered finding among his things, not only copied lyrics, but also what appeared to be his own verse. Since I had always used writing myself as a way to release and deal with emotions - I decided to purchase my son a journal - I would begin the first entry with a poem of my own and hopefully he would respond in turn. It was Saturday so there were two seperate visiting hours. My mom drove up - I ran into Wallmarts for a journal. The following is the poem that I wrote on that first page.
When darkness comes
And all seems lost
Find the glimmer
In the void - I am there

When swirling waters
Pull you down - down
Look for the hand
To pull you up - I am there

When demons circle
And grasp your soul
Rememeber a mother's love
Will never end - I am there
When I got to the hospital my son was in a better mood - he did complain about going to group sessions, but he had met a girl who he liked talking to and he was very happy with the large meal I had brought - his appetite seemed to be enormous and they explained that they had started him on risperdal, an antipsychotic, and one of the usual side effects was increased appetite - at the end of the visit I brought out the journal and in a non pressured way suggested that perhaps he would like to write some of his thoughts down - he nodded in a noncommital manner and it was time to leave till evening - I gave him a hug and this time he hugged back, holding on for a long moment; "I love you mom" he whispered - those simple words were like the sun rising after a particularily dark night - I left in the lightest mood that I had been in all week -To be cont.

8# Let it Be

On the way home the rain seemed to come down even harder. Water rushed against the car, now more of a boat. I attempted to get myself together - but it was as if all the stress and pain up to that point was gushing out with as much force as the rain slashing against the windshield. My girls tried to cheer me up -they used my son's ipod, which he was not allowed to have in the hospital to play songs to lighten the mood - nothing helped. Then they clicked on the Beatle's "Let it Be" - I've never been a huge fan, but something about that song spoke to me that night - The words that Mary spoke when faced with the tremendous responsiblility of carrying God's son in a strange way comforted me - the great responsiblity of dealing with a mentally ill child was not my decision - but I too could say or sing in this case "Let it Be" and bow to God's will - I had the girls play that song over and over and although I was still crying when we arrived home, my tears had decreased to a mere trickle - That night before crawling exhausted into bed, I got on my knees to pray - I let out all the immense grief that I could not overcome and I prayed for my poor son who I knew suffered even more than me - "Please God let me take on his pain. Please take it away from him - cripple me - humble me -destroy me if you must - just please, Oh Lord take away the terrible darkness on his soul!" I prayed as I never had before from the very depths of who I was as a human, as a mother and I meant every word. To be cont.

7# The Darkest Hour

That evening my two daughters and myself started out for the hospital - the journey began to seem almost biblical, for the unusually heavy January rain had continued - it felt like the sky had opened up to weep with me. Many rivers and small streams were flooding - the highway had become like the bridges to the Keys, just a ribbon of land between lapping flood waters. We had to detour several times due to road closings and after picking up my son's request for Wendy's we were running quite late - visiting hours only lasted a couple of hours so I was worried that he would be waiting impatiantly - he was near the door when we came in - following him into his room I, for the first time noticed the lack of privacy - all the rooms were open to a common room - no doors - which of course, I reminded myself made sense - they did, after all have to monitor the patient's every move - I had moderate hope that the visit would go well as my son gulped down his food and then started to describe some of the things he had done that day - but things went down hill from there - he suddenly sounded to me like the twelve year old perfect student he had once been - so eager to please - "this is my workbook I fill out in group" - he handed it around for our perusal - the situation became bizarre to me as I looked at the list of his possible diagnosis - a long list - he laughed "I have more on that list than any one else in the group" the last word caught and within a second he had collapsed on the bed - curling up in fetal position he began to sob - a sob that seemed full of all humanities' pain and despair. I have known parents who have lost a child - brothers and sisters who have lost a sibling - yet I had never heard anything that compared with those hopeless sobs. "So this is my life now" he said as he tried unsuccessfully to get himself together - I exchanged glances of complete shock and uncertainty with my daughters. Ironically although I had carried the child on the bed in my womb seventeen years before, I had no idea how to comfort him - but I tried. I sat down and tentatively put my arm around him - it did stop his sobs but not in the way I had imagined - he straightened up and went rather rigid, pulling away "it's your fault I'm here Mom - you should have let me die." What do you say to something like that? - I can't remeber my exact words - something about how I loved him so - and then I mumbled on about how everything is meant to be - he stood up and said, "well it's about time you go - I'll walk you to the door" -our visit had only lasted a half hour. We then exchanged pleasantries as if with a stranger and we walked back out into the pouring rain. To be cont.

Great Website

I did want to again interrupt the narrative to suggest a great website www.bpkids.com The site's main focus is bipolar disorder in children and teens, but the information and the support groups and chat can be a help to any parent dealing with their child's mental illness, whether the diagnosis is bipolar or not. I have signed up for one of the support groups and have found the comfort and wisdom an instant help.

6# Into a Well of Darkness

The next day I awoke with every intention of being positive - I realized that I couldn't help my son if I did not work on my own emotional health - but knowing and doing are two different things. I went into his room to clean - so he could get a fresh start when he got home and also to search for clues - hints of what nightmare led me to this day. I found more clues than I could handle - a poem he wrote the night of the attempt about darkness, death and hopelessness. In his passbooks from school I read a trail of breadcrumbs into madness - a year before the only entries were about schoolwork or girls - he even answered most of the interesting fact questions at the bottom of the pages - but then bit by bit disturbing images and dark song lyrics began to arise - tons of allusions to every drug under the sun and to insanity and death. I fell apart again - my good attention drained out as I sat on my son's floor. My mother called about then and hearing despair in my voice tried to comfort, to encourage - she told me that I needed to be a light in the darkness - that my son was living in total darkness right now and that I was his only hope for light - that light always overcome darkness and that I must pick myself up again. Somehow I did get off that floor - I didn't get much cleaning done - but I did get in the shower and get ready to travel to the hospital - wringing light out of the deepest part of my soul - hoping it would be enough to fight the darkness I knew I would be facing. To Be Cont.

5# Who Is This Boy?

The next day I again made the trip to the hospital in a mental fog. Worn out physically and emotionally I had to keep telling myself that I could stay strong - that I had to for my son. I didn't take my husband, who was emotionally a wreck from the recent deaths of first his brother and then his nephew - I knew that he would break down and that is not what my son needed. And so my mom drove me - I didn't feel competant just them to drive so far. I will never forget the moment I first walked into that ward. My son met me at the desk with a forced grin, but I didn't know him - that sounds terrible, but although the boy in front of was my son physically - he didn't seem in any other way to be the son I had known for almost seventeen years. His eyes had a vacant, yet haunted look, like the eyes of a wild animal in a closed cage. He began to mutter immediately "Mom get me out of here - I don't belong here - I'm going crazy in here." His voice was low, but somehow forceful - it carried threats of unknown horrors. I tried to comfort telling him that it would only be for a little while and this was where he would get the help he needed. He continued to smile - but his eyes didn't change - my beloved son was nowhere to be seen. Then came the meeting with the social worker - I ended up - despite my best intentions - crying again - I kept repeating "but he was the best of sons, how could this happen?" Intellectually I knew of course that mental illness can strike anyone - that intelligence, a loving family, good friends can not protect you. But still it seemed unreal - in my mind I kept seeing the straight A, quiet, caring perfectionist - it was as if I couldn't except that the wild eyed disturbed boy was truly my own son. After speaking alone for a while the counciler brought in that wild eyed boy and I learned that I hadn't even begun to understand the real terror of that he and now I was dealing with - he told of voices - of a voice commanding him to do things that he knew was wrong - that commanded him to kill himself because he was worthless. My illusion of a deep depression, which could be overcome, began to fade - I became physicall ill - sick at my stomauch and weak - I wanted to run out of there into the sane world outside and never come back . Before I left that day the wild eyed boy told me "Mom, I mean it, get me out - or I'll find a way to kill myself" - I walked out in a fractured haze half believeing that when I got home my real son would be there playing video games and this would have been only a terrible dream ... To be cont.

Another great site

I found another great website with both general information, lists of resources and even pamphlets and information pages that you can order for free - http://www.mentalhealth.samhsa.gov is a government site that covers a broad range of mental health topics. Besides basic facts, statistics,etc. there is a lot of information about the rights of the mentally ill and services that are available. A plus is also the extensive list of we links.

4# Where No Light Can Shine

For anyone who has never had a child in a psychiantric ward - it cannot be truly imagined - when we arrived that first night I had been awake for more than thirty six hours and my mind and thought was scattered in the storm that we drove through to get there - It was raining as it would in a summer downpour, but it was January in the Midwest and the rain didn't stop. Somewhere in the night it seemed that my soul had merged with the rain and I poured and poured out - perhaps there would be no ending. The nurse who helped me fill out the paperwork brought me out of my numbness a bit - as she spoke about rules and regulations - of all the items I couldn't bring my son because he could find a way to kill heimself with them - some of the stark reality began to seep in and I broke down and cried and though I was ashamed I couldn't stop - the nurse understood - I'm sure she had seen it many times before.
One of the hardest things I have ever done was leave him there that night - all I wanted to do was lay down and hold him in my arms, cradle him as I did when he was a baby - but I had to walk away and abandon him to that alien place - so different from the normal world at home that now appeared just a dream. To be Cont.