And starting to tame it
Reprinted from "Concurrent Disorders" issue of Visions Journal, 2004, 2(1), p. 22
In some ways I've just landed, treading solid ground instead of shifting sands. I'm a landed immigrant, having arrived from the Middle East four years ago. But in a broader sense, I've finally reached some real understanding of the dragon I've been running away from for over twenty years. During those two decades, I've lived in ten different cities, on four different continents - at least 40 addresses - countless temporary, part-time and casual jobs, lengthy periods of unemployment. Add in protracted periods of depression punctuated by manic episodes, plus a heady mix of alcohol and marijuana, and you have a fair idea of the chaos I've been struggling to come to terms with.
Naturally, I've spent quite a bit of energy trying to figure out what I've been trying to escape by all these moves and all this intoxication. My current understanding is that of 'dual diagnosis,' or 'concurrent disorder.' I'd like to tell you the story of how I reached this understanding, and of just how long it took me.
First came the acceptance that I had a real problem with depression. Faced with an anxiety that for the first time in my life had escalated to the point of physical shaking, I sought the assistance of my family doctor. While I was greeted with considerable understanding, I was given a very inappropriate drug, Paxil (paroxetine hydrochloride, one of the SSRI family of antidepressants). I found immediate relief from the anxiety, but after three months, manic symptoms returned. Particularly since I'd managed to quit both alcohol and marijuana, I'm convinced Paxil was responsible for what turned out to be a hypomanic episode, lasting four months. While not as devastating as some of my earlier 'drink-drugs-and-spending' manic sprees, this episode caused a fair bit of damage to my work, academic and personal lives. And when it was over, I was right back where I started - once again, acutely depressed.
The next realization for me was that I had bipolar disorder. It seems ridiculous that I didn't reach this conclusion earlier. How come nobody noticed? The insights I began gaining when I joined a local support group finally helped me to begin to reach my own diagnosis. This process was matched by a series of very unsatisfactory visits to a psychiatrist, who confirmed my suspicions but offered nothing in terms of treatment. I was given a diagnosis of 'bipolar, not otherwise specified.' Unfortunately for me, 'dual diagnosis' or 'concurrent disorder' was also not specified. Again, it was back to the family doctor, who started me on a course of valproicacid (the generic name for epakene, an anticonvulsant now widely used as a mood stabilizer). I was also given Paxil in the belief that the mood stabilizer would balance things off, and I would not be at risk for another manic episode.
During the next summer, my doses of both Paxil and valproic acid crept up. As well, I began to dabble with marijuana again. By the fall, my abstinence from alcohol had also ended. The stage was set for another mania, this time a full-blown episode. By the time the cycle ended with a return to the familiar winter depression, my marriage was over, I was homeless, and had no bank account or source of income. Out of this, I managed to piece together the final pieces of the puzzle - a jigsaw with the picture of my personal dragon, dual diagnosis, on it.
To deal with my acute depression, I began self-medicating with marijuana, with some measure of success - for a while. However, it became clear that this came at the cost of relationships with 'normal' people, and of not being able to complete my schoolwork. Through a contact at my support group, I made a visit to a dual diagnosis program run by the Vancouver Coastal Health Authority. The idea was that after signing in at ten drop-in sessions, I would graduate to a more formal program. All it took was three sessions. On the third visit, the penny finally dropped. We watched a video about heroin use, the reasons why people take it, and why they can't get off it. All of a sudden, my life was there on the TV screen. I'd prided myself that I'd never taken 'hard' drugs. Yet it was all there: the same issues, the same problems. I quit alcohol and marijuana immediately, and have managed what I'd rate as 99% success with both for over six months now.
And the outcome of all this? I have a new psychiatrist, don't drink, don't smoke, and take a much-reduced dose of valproic acid and Remeron (mirtazapine, a newer tetracylic antidepressant). I've completed my degree, found full-time work and a place I can afford to live in, and resolved most of the really difficult issues with my ex-wife. Things are still not easy, largely, I think, because I have to find ways to replace a lifetime of destructive social and personal habits with productive behaviour patterns. I'm sure that my understanding of what 'bipolar' and 'dual diagnosis' mean is different from anyone else's, but that's fine by me. I've found my dragon, and got a name for him. Now I've just got keep working on new ways to steal his flame.
About the author
Neil is a member of the Mood Disorders Association's Vancouver Support Group