Beyond Blue

John McManamy writes an exceptionally informative article on the types of Bipolar Disorder as defined by the DSM-IV (the shrink handbook). You can get to his article and others by clicking here. I have pasted it below.

There is far more to bipolar than meets the eye. Let’s start with the boring stuff:
The DSM-IV (the diagnostic Bible published by theAmerican Psychiatric Association) divides bipolar disorder into two types, rather unimaginatively labeled bipolar I and bipolar II. “Raging” and “Swinging” are far more apt:

Bipolar I

Raging bipolar (I) is characterized by at least one full-blown manic episode lasting at least one week or any duration if hospitalization is required. This may include inflated self-esteem or grandiosity, decreased need for sleep, being more talkative than usual, flight of ideas, distractibility, increase in goal-oriented activity, and excessive involvement in risky activities.
The symptoms are severe enough to disrupt the patient’s ability to work and socialize, and may require hospitalization to prevent harm to himself or others. The patient may lose touch with reality to the point of being psychotic.

The other option for raging bipolar is at least one “mixed” episode on the part of the patient. The DSM-IV is uncharacteristically vague as to what constitutes mixed, an accurate reflection of the confusion within the psychiatric profession. More tellingly, a mixed episode is almost impossible to explain to the public. One is literally “up” and “down” at the same time.

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Fortunately there are abundant resources on the Internet to help guide a person who hears a loved one talk about suicide, or who is suicidal himself.

I found the following material at Mayo Clinic’s page on suicide. Visit their site by clicking here, or print this out so that you have it handy the next time you are confronted by a suicidal loved one.

Hearing someone talk about suicide may make you uncomfortable. You may not be sure how to step in and help or even if you should take that person seriously.

Not everyone who thinks or talks about suicide actually attempts it. But it’s not true that people who talk about suicide won’t really try it. That’s why it’s important to take them seriously, especially if they have depression or another mental disorder or are intoxicated or behaving impulsively.

Potential warning signs of suicide

You may notice possible indications that a friend or loved one is thinking about suicide. Here are some typical warning signs:

* Talking about suicide, including making such statements as “I’m going to kill myself,” “I wish I was dead” or “I wish I hadn’t been born”

* Withdrawing from social contact and having an increased desire to be left alone

* Wide mood swings, such as being emotionally high one day and deeply discouraged the next

* Preoccupation with death and dying or violence

* Changes in routine, including eating or sleeping patterns

* Personality changes, such as becoming very outgoing after being shy

* Risky or self-destructive behavior, such as drug use or unsafe driving

* Giving away belongings or getting affairs in order

* Saying goodbye to people as if they won’t be seen again

Some people don’t reveal any suicidal feelings or actions. And many who consider or attempt suicide do so when you think they should be feeling better — during what may seem like a recovery from depression, for instance. That’s because they may finally be able to muster the emotional energy to take action on their feelings.

Questions to ask someone considering suicide

The best way to find out if someone is considering suicide is to directly ask. Asking them won’t give them the idea or push them into doing something self-destructive. To the contrary, your willingness to ask can decrease the risk of suicide by giving them an opportunity to talk about their feelings.

You may have to overcome your own discomfort to discuss the issue. Here are some questions you can ask someone you’re concerned about:

* Are you thinking about dying?

* Are you thinking about hurting yourself?

* Are you thinking about suicide?

* Have you thought about how you would do it?

* Do you know when you would do it?

* Do you have the means to do it?

Remember, it’s not your job to become a substitute for a mental health professional. But these basic questions can help you assess what sort of danger your friend or loved one might pose to themselves and then take appropriate action.

Don’t swear your discussions to secrecy. Not only is that an unwanted burden for you, but if you do make such a promise, you risk having to betray that trust if you need to enlist professional help. Don’t worry about losing a friendship when it’s a life that could be lost.

Do be supportive and empathetic, not judgmental. Listen to their concerns. Reassure them that help is available and that with appropriate treatment they can feel better. Don’t patronize them by simply saying that “everything will be OK,” that “things could be worse” or that they have “everything to live for.”

If possible, assess their home for potentially dangerous items. You may have to remove items that could become weapons of self-destruction, such as guns or knives. But don’t put yourself in harm’s way doing so, either.

Helping someone with thoughts of suicide find help

If your friend or loved one is at imminent risk of suicide, call the police or emergency personnel, or take them to a hospital emergency room if possible. Some people who are a danger to themselves may need to get help against their will, such as involuntary hospitalization. If possible, find out if they’re under the influence of alcohol or drugs or if they may have taken an overdose.

If the danger isn’t imminent, offer to work together to find appropriate help, and then follow through on your promise. Someone who is suicidal or has severe depression may not have the energy or motivation to find help on their own. You may be able to make phone calls to set up medical appointments or go along with them, or help sort through health insurance policies for benefits information.

Many types of help and support are available. If your friend or loved one doesn’t want to consult a doctor or mental health professional, suggest finding help from a support group, faith community or other trusted contact.

You can help when someone considers suicide

There’s no way to predict for sure who will attempt suicide. And although you’re not responsible for preventing someone from taking their own life, your intervention may help them see that other options are available.

Direct questioning, supportive listening and gentle but persistent guidance can help you bring hope and appropriate treatment to someone who believes suicide will offer the only relief.

I like this passage from Thomas Merton about Lent. It makes me think that Merton would approve of my Lenten resolution, to give up self-loathing. He writes:

The purpose of Lent is not only expiation, to satisfy the divine justice, but above all a preparation to rejoice in His love. And this preparation consists in receiving the gift of His mercy–a gift which we receive insofar as we open our hearts to it, casting out what cannot remain in the same room with mercy.

Now one of the things we must cast out first of all is fear. Fear narrows the little entrance to our heart. It shrinks up our capacity to love. It freezes up our power to give ourselves. If we were terrified of God as an inexorable judge, we would not confidently await His mercy, or approach Him trustfully in prayer. Our peace and our joy in Lent are a guarantee of grace.

I remember reading the following Washington Post article in December of 2005, when I was trying to figure out what in the heck was going on with me. It helped me to understand the nuances that exist within the family of bipolar disorder, and I was empowered by learning about the struggles of Andrew Solomon, the award-winning author of “The Noonday Demon: An Atlas of Depression,” because I regard with so much respect.

Here are the first few paragraphs of the piece, which you can get to by clicking here.

Like most teenagers, Andrew Solomon was often at the mercy of his moods — but in his case this situation persisted into his thirties.

“During my up periods, I’m lucid and articulate,” said Solomon, author of the partly autobiographical “The Noonday Demon: An Atlas of Depression,” which won the National Book Award for nonfiction in 2001. “I have clarity and can see patterns in my work, and I can write loads of publishable material in one night. I’m also very affectionate with people I care about.”

But when his moods would turn, as they invariably did, he could withdraw or have angry outbursts.
Once, after an annoying phone call, he slammed down the phone so hard it broke. Another time, when an acquaintance who frequently drank too much showed up at his home tipsy and immediately poured herself a cocktail, Solomon “smashed the glass and yelled at her that she had to leave immediately,” he recalls. After such explosions, he would “spend the next week apologizing.”

Yet it wasn’t until three years ago that Solomon, now 42, learned there is a word for the mood swings that have affected him since his youth: cyclothymia.

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