Thursday, August 29, 2013

Memory Functioning in Depressive Disorders and Bipolar Depression




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If you enjoy or benefit from the information you gain from this blog, or see the importance of it for yourself or for others in understanding and working on your/their mental health conditions or if you're in the mental health professions or otherwise see the importance of the work done and presented in this blog, please consider donating and supporting it. 

All the writing and research is done by a single individual - Brad Esau - who himself has been disabled due to the long term effects of his condition and who lives on a very minimal pension and thus has great difficulty supporting himself. 

For a one time donation, you can simply follow this link and instructions there - https://www.paypal.me/TamingThePolarBears

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Your donation goes to a fund controlled by a third party team who support Brad and his Taming the Polar Bears project (Gregory Esau is his brother and the fund bank account is in his name). 

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Tuesday, August 13, 2013

My Positive Difference Making Fundamentals

Positive Difference Making
Things That CAN be Done




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Support Taming the Polar Bears

 

If you enjoy or benefit from the information you gain from this blog, or see the importance of it for yourself or for others in understanding and working on your/their mental health conditions or if you're in the mental health professions or otherwise see the importance of the work done and presented in this blog, please consider donating and supporting it. 

All the writing and research is done by a single individual - Brad Esau - who himself has been disabled due to the long term effects of his condition and who lives on a very minimal pension and thus has great difficulty supporting himself. 

For a one time donation, you can simply follow this link and instructions there - https://www.paypal.me/TamingThePolarBears

Don't have a PayPal account? No worries, getting one is fast and free.

Your donation goes to a fund controlled by a third party team who support Brad and his Taming the Polar Bears project (Gregory Esau is his brother and the fund bank account is in his name). 

Or if you'd like to make a regular small monthly contribution, please contact this email address - lanina1101@gmail.com - and include in the subject line: monthly donation with the amount you wish to donate on a monthly basis. 

Please state your PayPal address and name in the email.


Thank you so much for your support!

Saturday, August 10, 2013

The Myths of the "Benefits" of Psychiatric Drugs



Note - this post has been edited since its original writing to include links to source materials and for further reading. BGE - February 5, 2014


It is unlikely you will believe in the information I am about to give here. For the vast majority of people information of this kind strikes a strong cognitive dissonance within them. For people love their drugs. People believe in their drugs. People want to believe there are magic bullets in a pill that are going to make things better. (1) But this is a myth. According to a McLean's magazine article earlier this year prescription drugs lead to 100,000 deaths a year in the US and 10,000 in Canada, many of these from psychiatric drugs.

I am a psychiatric survivor. When I survived the worst of what was several horrific episodes of suicidal psychosis and then found that the very drugs I was given by doctors to “make me better” were in large part responsible, I vowed to do what I could to dispel the myths – I might say propaganda – that pharmaceutical drugs produce better outcomes for psychiatric illnesses. I devote my book Dancing in the Dark – Why?  to dispelling these myths and now I will devote more space in this blog.

Myth #1 – schizophrenics have to stay on their medications. Even after starting my research into psychiatric drugs I still believed this one but many studies show better long term outcomes with non-medicated treatment than with medicated treatment. The key term is long term. Drugs can knock down psychosis in the short term but will produce worsening outcomes over the long term. “Outcome” means being able to get back to a normal life. There are several reasons for this, not the least of which is the damage drugs will have on cognitive functioning and on motor movement. Anti-psychotics have been shown in long term studies to increase psychosis. A fifteen year study done at the University of Illinois comparing medicated and non-medicated schizophrenics found that forty percent of non-medicated patients recovered versus only six percent for medicated. Not only that but the “poor outcome” category was much higher on anti-psychotics than for non-medicated, forty-nine percent versus only sixteen percent. In the 1970's a Dr Mosher started a schizophrenia treatment centre called Soteria House in which no medications were used. A five year follow up of patients showed that seventy percent were able to return to normal lives, an astonishing success rate. In addition I came across many personal stories of sufferers of schizophrenia who didn't start getting better until after they stopped taking their medications and got out of psychiatric hospitals. 

A full paper on the Soteria House project and the results can be found here - http://www.moshersoteria.com/articles/soteria-and-other-alternatives-to-acute-psychiatric-hospitalization/

The Harrow long term study on medicated and non-medicated outcomes for those with the diagnosis of schizophrenia can be found here

Not only that, but research by renowned neuroscientist Nancy Andreasen  has found that long term use of anti-psychotics causes loss of brain tissue

I had a single incidence of suicidal psychosis prior to being put on anti-psychotics. The  number and severity of incidences increased while I was on anti-psychotics. I had the one most severe episode since I stopped (the effects stay in the brain for some time even after stopping) and none since that time.

Myth #2 – psychiatric illnesses are caused by “chemical imbalances”. This was a theory several decades ago but it's one for which there is no proof despite decades of efforts to produce proof. That it is still believed by a majority of people is a byproduct of pharmaceutical company propaganda and our own desire to believe in the properties of magic bullet fixes for conditions like depression. You can try as you might, but you will find no study or discovery proving that any psychiatric illness is caused by a chemical imbalance. Actually, you will find no study or discovery proving any cause or etiology of any of the major psychiatric illnesses. If you find one, head straight to the Nobel prize committee because that would be major medical news. A good primer for some background reading on the history of the chemical imbalance theory and the media's role in its promotion can be found here - The Media and the Chemical Imbalance Theory of Depression

Myth #3 – anti-depressants “fix” a chemical imbalance and thus “lift” depression. One, there is no such thing as a chemical imbalance so how could anti-depressants fix one in your brain? Two, there are countless studies showing that anti-depressants fail to outperform placebos. There are studies that show just a pill the same colour and shape as an anti-depressant will have positive benefits. Three, there are studies that show links between anti-depressant use and increased and prolonged depression, an effect I can personally attest to.





Myth #4 – psychiatric drugs are “safe”. I can personally attest that they are not. People who know me and saw my worsening condition can attest they are not. But numerous studies using brain scan technology show detrimental changes in brain tissue with psychiatric drug use. There are numerous studies linking anti-depressants to suicide and even murder. A brief summary of this can be found here - Psychiatric Drugs and Violence. And something that needs to be understood is that anything that receives a government warning is only the tip of the iceberg and a toned down version of actual cases. 

Anti-psychotics impair or damage the basal ganglia leading to tardive dyskinesia, an involuntary muscle movement disorder which then ironically is assumed to be a symptom of schizophrenia. Brain researcher Nancy Andreasen's long term studies showed irrefutable evidence that anti-psychotic use leads to shrinkage of brain volume with the extent of the damage being dose related. In other words, the higher the dosage, the more damage was recorded over time. 

There are also many studies connecting anti-depressants to increased risk of suicide, an effect I can personally attest to. Researcher David Healy is a leader in this field of study, establishing both the links between SSRI use and increased suicides

Myth #5 - The FDA and Health Canada tightly regulate drugs. One of the things I found out early on when I started researching psychiatric drugs was how shocking the approval process was. In Canada it's virtually run by the industry itself. The FDA board is dominated by ex pharmaceutical executives. Doctor, researcher and writer Ben Goldacre in his book Bad Pharma exposes how drug companies rig tests and outcomes of drug trials. Since the start of the pharmacological era drug trials have never been as rigorous as you might imagine and that is true to this day. If you believe that pharmaceutical drugs are safe when they hit the market, you have a lot to learn. 

Myth #6 – pharmaceutical drugs are improving our lives and saving lives. This is the biggest myth of them all. As mentioned, tens of thousands of deaths per year are related to pharmaceutical drugs. I heard a statistic about one in five people having a psychiatric disorder. But we are consuming pharmaceutical drugs to the tune of billions of dollars per year. If drugs “improve lives” why then are so many people still ill? Pulitizer Prize nominated science writer Robert Whitaker has devoted himself to researching these questions. He's produced two books and writes a column for Psychology Today. He looked into disability numbers for psychiatric illnesses and found a correlating rise in disability rates with the start of the pharmacological era of psychiatric treatment. If drugs make us “better”, why are more – dramatically more – people being permanently disabled by illnesses such as schizophrenia, bipolar and depression? Whitaker's research showed that long term outcomes for all of those illnesses were better before the pharmacological era (which started in the late fifties).


For me, bipolar has been no picnic. I have had some good episodes of creative mania but also a lot of struggles. But absolutely by far the worst of those struggles and the worst of my suicidal risk came while I was under the care of psychiatrists and taking a large variety of psychiatric drugs. Prior to my experience I believed the myths, I believed in “better living through pharmacology”. That belief almost cost me my life. That belief does cost many people their lives. 


















(1) - If you are currently taking psychiatric drugs for any condition, please do NOT consider stopping them without first consulting a doctor who specializes in dealing with psychiatric drug withdrawal nor before drawing up a careful plan to improve your mental health.



Tuesday, August 6, 2013

Realities Continued




Some general stuff and some personal perspectives.

These concepts of the "realities" that schizophrenia and bipolar create in sufferers' minds are hard for anyone to conceptualize. People want to believe that it's just "thoughts" or some state of mind you can make go away if you just try hard enough or worse that it's something you're just bringing on yourself. This is incredible frustrating. The implications are twofold; one is that it's somehow a choice as to what we have in our heads or how our heads are operating and two, that it's not "real". There's a third one but I'll get to that at the end.

I have some fascinating material from the Hearing Voices Network regarding people who hear voices and their frustrations and distrust of the folks in the white coats. Unfortunately, as I'm not currently living in a home of my own and all my things were packed away for me (during my latest hospitalization), I don't have access to the material but I'll muddle along as best I can with my imperfect memory. It was from research into schizophrenics by famed Dutch psychiatrist Marius Romme. What he went on to discover was that hearing voices was something separate from or not necessarily connected to schizophrenia (despite this being more than 20 years ago and the now incredible body of evidence the clods at the American Psychiatric Association refuse to acknowledge this). Without getting into the politics of psychiatry (which I easily could!) what Romme found among those who hear voices is an incredible frustration with the psychiatric profession and/or other doctors. Number one is that the people knew they were not schizophrenic, only - and "only" is not a great word here - that they heard voices. Romme uncovered - in sort of a literal sense of the word - hundreds of "hearing voices people" who'd gone underground with their problem because of this frustration with with the professions. They were regular people with regular jobs and lives who just happened to hear voices and the profession wanted to label them, put them in hospitals and drug them. Worse, the profession showed no understanding of the issue of hearing voices. Doctors would, invariably, insist that the voices were not real. Well no, the people would strongly feel, they absolutely are real. And back and forth it would go and the doctors only recourse would be to prescribe drugs which they insisted would make the voices go away. The drugs didn't make the voices go away. The people became so frustrated and displeased that they, as mentioned, simply went underground and found methods on their own to cope. It was Romme's work and discovery of this group that would lead to their banding together and the founding of the Hearing Voices Network, a peer to peer group for people to talk about any kind of inner mind phenomenon that uncomprehending pencil pushing doctors don't understand. I've attended local meetings of this group and I nearly cried it felt so good to be around people who get the weirdness that goes on inside my head. They listen, they understand, they don't judge, they don't try to tell you that you're "just imagining it". They GET IT.

Oh dear, I did get carried away there, didn't I. The point was, however, to further the concept of different inner realities through the use of hearing voices. For hearing voices people the voices they hear are NOT their imagination and they don't simply just go away (with lots of work for many people they can), the voices ARE real. The other point is how frustrating it can be to be told this stuff going on in your head is not real or that it's just your imagination or that drugs make it go away or that you're just not trying hard enough and so on. As I said, after dealing with so many people who told me the most hurtful things (while attempting to be well meaning, I know, but still), it felt so wonderfully good to be with and talk with people who got what I was experiencing. They are a wonderful, wonderful group and organization. It was through attending these groups that I FINALLY understood my suicidal psychosis episodes, something that the dimwits in the white coats never listened to me about or explained. I shouldn't say dimwits, I know, but after a baker's dozen of them, all with different views, methods and so on ranging from nothing's wrong to the worst case of bipolar and continuing to get WORSE and then finally finding out on my own what was going on and getting far better through my own efforts (not unlike the hearing voices people who finally, fed up, went underground), sorry, I think they're dimwits. And that's by far the mildest term I can think of. You should hear me when I get wound up about what I really think. Trust me, I'd peel paint off the walls with my language. There are people who saw, and were horrified, by what I went through that would too.

Oh, one of the standard treatments for schizophrenic and bipolar peeps is antipsychotics. "Anti" + "psychotic" = something that reduces psychosis, right? (well, they don't prescribe it for that in bipolar peeps really. They just have this vague idea that it helps "knock down" mania). Well, it turns out that it can actually make psychosis worse. Something that I personally discovered myself. Not fun. I'll give you the studies and the science on this another day though. But back to inner realities.

Bipolar creates a lot of inner realities. I'm not even sure I can describe them all. As I said in a previous column, bipolar (and schizophrenia as well, I suspect) are whatever it is plus your own personality. I have plenty of my own personality quirks and bipolar just takes those and magnifies them (sometimes this is good though). How this all works is an utter and complete mystery (and trust me that it is a mystery, I am extremely well read on this not to mention all my own "data" in my head plus interviewing several bipolar people). I've had many manic episodes in my life, no two of them the same (though some similar). Sometimes they're great, sometimes they're horrible. I'm pretty sure that my suicidal psychotic episodes were just twisted variations on my mania and manic visions. That would rate as pretty bad. Other manic episodes played visions of lovely stories in my head that were literally like watching a movie in my mind. Not like a dream, very different from that. Like a movie, like a vision. An hour or more long. I just "sat back and watched". In one manic episode I was going to be a head coach for a team in the top professional hockey league in the world, in another I was going to take over and save a major corporation that was going through difficulties. None of this is conjured up by any effort from me. It just comes. From where, no one knows. Why? No one knows. It just comes and completely takes over my brain.

Depression visits upon me some horrible times. Again, it just comes. I don't make it happen, I don't wish it to happen, nothing happens. It just comes. The mind just works very darkly during these times. I cannot control it, I cannot make it go away. Now, with years and years of experience, I can have have some insight but only perhaps after some time can I realize what's going on. Maybe. It's a LOT of work.

Mania, depression, mixed episodes, all kinds of variations in between, these just happen and when they happen that's my - or any sufferer's - reality for that day, or week or month or moment. There's nothing we can do about it, that's what you have to understand. Awareness can help, yes, but only maybe. It depends on how strong any given event is. Most often it's only after that we can look back and think, "right. that was <insert the type> episode. It's passed now and I can settle down". Or many, many, many variations of such.

It's a myth that drugs make things "all bettah". People have the nerve to tell me - based on what, I can only imagine - that all I have to do is "get the right combination of medications" or "tweak my medications". I know they're being well meaning and only want to give me hope but honestly. I've had - my latest count - eighteen psychiatrists or residents. I've been on every combo there is. And I just got horrifically, horrifically worse. So don't tell me about meds. I spend about four chapters and a hundred thousand words in my book dispelling those myths so I won't get into that here.

I think there are methods. Peer to peer counseling is one. (I'll no longer deal with people who haven't been through this before). Meditation is another. I'm pretty deeply read in neuroscience. I think there are signs of hope there, especially in neuroplasticity.

I also know that I am in the highest risk group there is for bipolar. I'm older and have had it all my life and have cycled through countless cycles of mania and depression. This is well understood in the literature. All the literature that talks about hope talks about young people, those who've only had a cycle or two. Like any illness, it's much better when caught early. Twenty percent of bipolar sufferers will commit suicide. I'm in the the high risk group for that, something that I looked into in a series of three earlier posts. I know I have some very serious challenges ahead, something that would be stupid to ignore.

People write to me and tell me that they've been through this or that and survived. That's sweet. But it misses the point. Illnesses of the brain are different. When your body is sick you still have the most important weapon available to you - your brain. When you're sick with a brain disorder, your most valuable weapon - your brain - is the very thing that's not healthy. I don't know how to get across how much more challenging this makes things. Not to mention that the brain is one of the most mysterious structures in the universe (ask a neuroscientist like David Eagleman). Honestly. We understand more about distant stars than we do about the human brain. This is not to say that major illnesses such as cancer are somehow easier to deal with. Of course they're not. And I'm grateful that generally I have have my health. I'm just saying that brain illness are not only tough but they're tough because the power of the brain is what we need most to get better from anything.

I've heard people compare brain illnesses to cancer and such. Which is a nice try. I'd argue, however, that they're possibly worse (especially the worst cases of schizophrenia and bipolar). I say worse because we know so little about the brain and don't for a moment believe that "doctors" really understand what schizophrenia and bipolar are. They don't. Don't let their impressive web sites fool you. They don't, as I've been trying to get across, know where schizophrenia or bipolar come from or why they happen or where any of the visions and different realities come from. All they have, and know, is an incomplete understanding of behaviours and some crude drugs with which to try (all of which produce worse long term outcomes).

But onward and upward. There ARE things to work on and I will get to those at some point.

Sunday, August 4, 2013

Mental Health Disorders and "Reality"



This isn't going to be what I'd like it to be because I don't, in my current state of residence, have access to all my notes and books nor do I have the mental energy to go through and search online to find all the stuff I'd previously researched and try to reconstruct it. So we'll just have to make do with what I can do on the fly. Which is probably a good thing because what I'd like this to be would run three thousand plus words or so, not something anyone has the time nor interest to plow through.

As I made at least somewhat clear in the previous post, we all have our own realities and those realities change as our brains change which is like ... all the time. But that's normal human change almost everyone goes through. As I was building to in the previous post, which I hope you have read as a prerequisite  of this post, the state changes and reality changes experienced by those with schizophrenia and bipolar are rather different from that. I can only briefly touch on each of these today but hopefully it's enough to start opening some minds.

Schizophrenia:

Schizophrenia is many things, many probably not quite as how you imagine them. For one thing it is NOT hearing voices. The phenomenon of hearing voices is quite different and not - or at least not necessarily - anything to do with schizophrenia. This is a massive myth, unfortunately one that is propagated by educated people with "Dr" in front of their names. But go to a meeting of Hearing Voices Network and/or read through the copious amount of material they could give you and you'll find out something very different from mainstream medical opinion. This does not mean that some people with schizophrenia may not experience, as part of their delusions, hearing voices, only that hearing voices does not necessarily equate with being schizophrenic. So let's set that aside right away. What we are talking about are delusions which are described somewhat incompletely here. 

Rather than try to broadly describe schizophrenic delusions - which can vary greatly from person to person - I'll work instead with a very well known case study: that of one John A Beautiful Mind Nash. John Nash, if you don't care to follow the link and learn more about him, was - probably still is at the age of 85 - a mathematician. But not just a mathematician; he was one of the most brilliant mathematicians among a collection of the many of the most brilliant mathematicians on the planet at the time (the late 40's to mid 50's of the last century at Princeton University). He would win a Nobel Prize for his ground breaking work in game theory. And it wasn't just that he was brilliant, it was how he was brilliant. He could, it was said, simply do things with his brain that no one else could do (part of his brilliance was in being a maverick among his peers). So we're talking one very smart man here. And not long after this wonderfully brilliant man developed game theory he began, around 1959 or so, to experience delusions (if you have seen the movie on Nash's life you'll have to set that aside as it was really rather fictional I can tell you). It is hard, even for the most excellent biographer of Nash Sylvia Nasar (the more accurate portrayal of his life and experience with schizophrenia), to describe Nash's delusions because he never actually gave an interview to her so instead all there is to go by is his behaviour and second party accounts from family and former colleagues. 

It is not possible to completely describe here within the constraints of a small column all of what Nash experienced and did while delusions took possession of his mind. In 1958 he was working on extremely advanced mathematics. Then the inner realities of Nash began to change. It started mildly. He started to feel that all men who wore red ties were part of a communist conspiracy against him. Not long later he was chasing around Europe as an "attache" of aliens in charge of contacting embassies on a new world order and world government that was coming. And this was, it's important to understand, completely and one hundred percent real to him in his mind. He believed it was real, as he told a colleague some years later, because it came from the same place in his mind as his math theories did. His behaviour changed completely and utterly to follow his new reality. He became for all intents and purpose unemployable. He more or less lost all interest in mathematics as the new "realities" took over. He was institutionalized undergoing treatment that included the barbaric insulin shock therapy which had untold and long term effects on his mind (he would later refuse any  institution or treatment and his wife was said to have rejected electroconvulsive therapy for him because she feared what it'd do to his mind).

The take away here is that schizophrenia can produce new inner realities over which the sufferer has no control. No one knows for sure where the delusions come from or why. Schizophrenic delusions can happen to almost anyone from any background. While Nash gradually, over many years (and famously without medications), was able to distinguish his delusions as not real and get back to "real" reality, for most people this is extremely difficult. The delusions can come and go over the years and each time they're absolutely real. It is a reality virtually no one outside the sufferer can imagine. Which is part of what makes it so difficult for the sufferer - they're the only one that can "see" it and this can be extremely frustrating (and this frustration, I argue in my book, becomes a huge part of the "illness"). I once talked to a man "to whom Jesus spoke" and gave him tasks to do. He was absolutely sincere in how real this was yet no one would listen to him. Though he'd gotten used to this rejection and appeared very nonplussed about it, I could still sense the frustration in his voice, not to mention his bewilderment at why no one wanted to hear, through him, what Jesus had to say. He thought it so important and couldn't grasp why no news services wanted to interview him on this. 

Bipolar:

Bipolar can be quite similar to schizophrenia in that it can produce delusional thinking and indeed one can be misdiagnosed as the other. Kurt Vonnegut's son Mark in his book Just Like Someone Without Mental Illness, Only More So describes what sounds much more like schizophrenia to me but he was diagnosed with and treated for bipolar. Whatever it was, he managed to deal with it quite well having gotten accepted at Harvard Medical school (albeit against very long odds) and became a successful doctor (except for the relapse time). Like schizophrenia, bipolar can create some pretty wacky stuff in one's mind all of which is one hundred percent absolutely real to the person in whose brain it's happening. I can personally attest to this. The younger Vonnegut doesn't describe swings of mental states or manic depressive episodes (I use the term "manic depressive episodes" to denote the depressed state of bipolar, a condition I think is different from unipolar depression), something which further makes his diagnosis suspect to me. 

Bipolar is essentially swings in state (I dislike the word "mood") between mania and depression. Mania is many things so it's hard to precisely define here. I once described it as whatever one's personality is with manic chemistry layered over top of that. If you tend towards creativity, you'll be manically creative. If you tend to do stupid stuff, you'll do manically (and epically) stupid stuff. If you're an abusive a-hole, you'll be a manically epic abusive a-hole who can do violent things. I don't know where to begin and end in describing mania. I could describe mine but it's different from many people's. My mania is very often different from itself. They're like some boxes of chocolates; no two are alike. Whatever it is, it'll be an elevated state in which you are impelled to do stuff very different from what you'd normally do (or maybe, like some creative bipolars, your normal stuff much better than you ever do). This - for however long it lasts - will be your reality. And what mania does as part of making this your reality is remove all insight or judgment. No matter how lunatic whatever it is you're doing, it will make absolute sense to you at the time. Including, tragically, maybe jumping off of a building because you're convinced you're Superman. Yes, it can be like that. Like with schizophrenic delusions, no one knows where these manic bouts come from or why. It just happens. Just like that <snaps fingers>. There are thought to be triggers but these don't always necessarily happen first. 

Then the worst sufferers (though not all apparently) of bipolar will experience an abrupt change from this "up and energetic" state down to the absolute blackest, deepest, darkest depths of depression humanly imaginable. Just. Like. That. (or at least many times for me anyway). Then this becomes the new reality. Like with the highs, there will be very impaired insight. This is part of what makes manic depression such a suicide danger - killing oneself makes absolute sense (never mind the desire to escape the darkness and psychic pain) and your mind will be in complete agreement. Rather than the runaway optimism of mania, manic depression is all about the darkest negativity and pessimism you can imagine. As great as you thought you were when manic, you'll think you're as awful when in the grip of manic depression. It'll be like an oil derrick pumping your worst memories and thoughts into your mind. And because you're robbed of insight and it's just the way manic depression works, this negative darkeness will be your reality. It is completely and utterly hideous. And yet so real. And you can't do anything about it. It's hard to tell which lack of insight is worse - that at the high end or that at the low end. 

Then there are "mixed episodes". This is a whole different reality altogether again. This is the nuclear power of mania coupled with the darkness of depression. Or maybe just acting like a totally out of control (because you are out of control) asshole. Because your mind has been taken over by something else and that's your reality for that particular time and you're just quite sensibly acting on that reality. 

You can "rapid cycle" through these highly different states in kind of an internal roller coaster or yo-yo where your entire mental state - or reality - is changing from one to the other and back again so fast you have no idea what is what. You'll want to put a gun to your head and pull the trigger just to make them stop. Trust me, they will drive you that insane (don't worry, most people don't get to that state). The longer this happens in your life the harder it is to treat and the worse your long term prognosis is.

None of these states - these inner realities - you have any control over. They just happen. Generally you'll be utterly unaware of them coming; it'll just be how your brain is for those weeks or months. With therapy and great effort one can learn to be more self-aware and deal with them better. Or not. It depends.

Medication kind of helps but only by turning you into a zombie, yet another inner reality to get used to. (this is for many though not all people ... medications WILL change you though and only maybe for the better ... this is a deep and controversial subject, however, though it is a favourite of mine). 

Oh - and aside from these wild reality changes that schizophrenia and bipolar can bring, we still get all those normal changes that everyone else gets which we looked at in the last column. Just like you, we can be grumpy, moody, giddy and all that stuff. In the case of bipolar, that might just get amped up several gazillion watts. You just never know. It's all kind of like having your mind run by a roulette wheel; who knows where the ball stops. It's important here now to understand just how different these changes in inner realities are from "normal" changes in reality. We're not talking changes due to feeling grumpy or happy or things like that. And you can have insight into those changes; you can tell "oh, I'm just crabby today. I'll feel better tomorrow". Not so with schizophrenia or bipolar. Lack of insight is a big part of these disorders (at least for the higher ends). So if, from the previous piece on reality, you thought your hold on it was tenuous, just imagine what it's like for schizophrenic or bipolar peeps!

This is not to sound negative, only to give some ideas as to the difficulties that those with schizophrenia and bipolar go through. Both these disorders literally take over a brain and make it something else, producing wildly different realities. But there is hope. That, however, is for another column.