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Old 03-13-05, 09:41 PM
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The curse of a bipolar disorder: Ecstacy & Despair

By Eric Fleischauer
DAILY Staff Writer
eric@decaturdaily.com 340-2435

Adorned with dim chandeliers and heavy silence, the Huntsville funeral home holding the ashes of Linda Beshears clashed with the view from its foyer.


DAILY Photo by Emily Saunders
Family and friends remembered Linda Beshears, inset, through her funeral urn, a crocheted blanket and flowers during a memorial service Sunday at Twickenham Funeral Home.
The clash between inside solemnity and outside commerce echoed the self-destructive impulses within a woman who worked tirelessly for her family, but felt responsible for crimes that she could not have committed.

A Wal-Mart bustled with shoppers as last week's memorial took its course, customers' horns and voices made quiet by thick windowpanes. People yanked at doors and pulled at furniture at the U-Haul shop next door, eager to get from here to there. A steady stream of people trickled into Hollywood Video, emerging in minutes with their $4 escapes in hand.

High cost of escape

For Beshears of Lacey's Spring, the cost of escape from internal clashes between mania and depression was high. The coroner labeled her death suicide, but the 120 people at her memorial service knew better.

Beshears died from the disease that plagued her for the last eight years of her life. She died of the internal war called bipolar disorder.

One in 20 suffering from bipolar disorder ultimately kill themselves. One in two try.

Beshears' death tracked the emotional extremes that plagued her. Doused in gasoline, she flamed in heat so extreme it melted the windows of her car.

Then she immersed her burned body in the frigid waters of the Tennessee River in Morgan County.

While Beshears' life was the most recent one snatched by bipolar disorder in this area, it was not the first.

In August, Janet Pearsall Haney, 26, killed herself with carbon monoxide by locking herself in a shed with her running car. In January 2004, 29-year-old Farron Barksdale, saddled by the disorder, shot and killed two police officers.

What is bipolar?

Bipolar disorder typically involves alternating cycles of mania and depression that lead to abnormal behavior. The most serious cases are a living hell as patients and families try desperately to find an unclouded reality, an emotional baseline.

People suffering from a manic episode are either euphoric or irritable. Other symptoms of mania, according to Dr. Andree Stoves at The University of Alabama at Birmingham Medical Center, include impulsiveness, decreased need for sleep, hypersexuality and dramatic increases in energy level.

"They feel grandiose," explained Stoves, who is director of psychiatric emergency services and psychiatric consultation services at UAB Medical Center. "They may even think they are having special communications from God. They often feel invincible."

The depressive episodes are just as bad.

"This is not the blues. You can't pull yourself up by the bootstraps," said Larry Cantor, Ph.D., a director at Decatur General Hospital West. "Some don't know how to live. Some feel death is the only answer."

Some with severe bipolar disorder develop a compulsion for self-injury, particularly "cutting." The term means something broader than suicide, but typically involves a laceration to the wrist.

Sometimes the intent is suicide, but at other times it is a means to break the mood cycling. At other times, it is a cry for help as a patient realizes he or she is losing his battle against suicide.

Listing the symptoms of bipolar is easy. Understanding the disorder's toll is not.

"No one understands being bipolar," said a 47-year-old woman suffering from the condition.

Like many of those suffering from the disorder, she will not use her real name due to the stigma associated with the diagnosis. She asked to be called "Rosebud."

"Other bipolars can't understand being me," Rosebud said. "I can't understand being other bipolars."

The cause of bipolar disorder is not well understood. There is a definite genetic component. Most who suffer from the disorder have a relative who also had it, but one identical twin may have bipolar disorder when the other does not.

"Extremely stressful situations can cause symptoms to manifest," according to Stoves. "So can the use of drugs. ... They may not be able to tolerate a stressor like a normal brain would."

From the inside

The disease is bad enough. It is made worse for patients who experience social condemnation for the diagnosis.

Forty-year-old Randy said, "You can't imagine what it is like with the mental-illness label. It seems that with any other body part, it is socially acceptable for it to go bad, but if it's the brain, then you're a social leper."

Rosebud explains.

"Bipolars have to learn to be actors and actresses. People don't like us if they know what we are. I don't ever tell anyone what I am."

While the extremes of mania can be horrifying replete with paranoia, irrational guilt and delusions the less dramatic hypomania is sometimes pleasant.

Rosebud's nearly overwhelming anger at what bipolar disorder has done to her life includes frustration about her manic episodes.

"So I am stuck ... in this hell-hole of depression. I can't even be a decent bipolar," Rosebud said. "I can't go full-manic because of my ministry background. It holds me back from being the bad-girl, hypersexual person."

Forty-year-old "Shout" said the disorder is nerve-wracking even when its symptoms dissipate.

"Bipolar is never knowing who you really are," Shout said. "When you are manic, you are wonderful and when depressed, you are s---. When you're stable, you spend much of your time worrying that it won't last."

Manic episodes

One person with bipolar said he woke up at 3 a.m. in a manic phase and proceeded to paint his basement in tropical colors. On Sept. 11, 2001, he feared the planes were headed for him, so he hid behind a chair with his "last meal," a bowl of cereal.

Some of those suffering from severe mania have a bond with their co-sufferers. Some can laugh at their antics, but not for long.

One man had a "magic pen" during a manic episode. He talked to it and it talked back as it helped him write a novel.

Another woman recalled pulling her pants down in a crowded restaurant, mooning a table of businessmen. The story triggered amusement from others who share her diagnosis, until she continued. "I want someone to put their arms around me and tell me it will be OK. I'm flying free, but scared."

Before shooting two police officers last year, Barksdale suffered severe paranoia as a result of his bipolar disorder, his lawyer said. Paranoia is sometimes a symptom of mania.

Beshears was apparently delusional, believing that she was responsible for terrorist attacks. She told a rescuer that the only way she could stop the violence she caused was to kill herself.

Treatment of bipolar

Stoves said this is an exciting time in the research of treatments for the disorder. She hopes that ongoing genetic research will lead to treatment, and an increasing number of medications are available to ease symptoms.

"Several drugs have gotten FDA approval for the management of manic episodes, and drugs are being found almost daily that modulate symptoms. There is even some research suggesting certain nutritional things, changes in food and diet, can affect the outcome," Stoves said.

Most people with bipolar disorder respond well to mood-stabilizing medication. For some, the problem is making themselves take it.

Cantor said one reason it is difficult to get bipolar patients to take medicine is that it disrupts the pleasure they feel during their hypomanic episodes. Some experience boundless optimism and creativity during these phases.

Their self-impression is not always off. Cantor said many successful businessmen and artists suffer from the disease. During their manic stages they are geniuses, but they come down hard when the depressive episodes hit.

"Some feel able to get a lot done, very confident," Stoves said. "The last thing they want is for someone to rain on their parade."

Getting patients to take medicine during depressive episodes is difficult for other reasons.

"They feel so depressed that they may be too exhausted to physically get up and get their medications," Stoves said. "Sometimes they feel so hopeless that they decide there is no need to take the medicines anyway, that it won't help."

For some patients, the disease becomes a part of their identity.

A bipolar woman reacted with fury to a bad interview question. Once her anger abated, she explained.

"My reaction to you describing my illness as 'hideous' was understandable when you consider how closely some of us identify with our disease. How could I not take your description personally?" she said.

The unwillingness to take medication is fodder for many an academic debate.

"I have always felt strong about civil rights," explained Cantor, "but this is a tough issue."

Alabama has an involuntary commitment law, but some consider it hard to use and sometimes slower than necessary for the protection of the patient or for the protection of others.

Limestone County Probate Court records indicate Barksdale was committed on several occasions. He would stabilize on medications, be released, and then stop taking them.

"What do we do? We know if we could just put them asleep for 72 hours, they would wake up as a different person," Cantor said.

While counseling is an important part in the treatment of those with bipolar disorder, it is not always successful in preventing suicide. Lessons learned between episodes may not stick.

"It's very difficult for people when they are in a given mood state to recall clearly when they didn't feel that way," Stoves said.

"Guilty ruminations," the term doctors use to describe symptoms such as those expressed by Beshears, are often present in severe bipolar disorder. They sincerely believe they are responsible for things over which they have no control.

"For most (bipolar) people who commit suicide," Stoves said, "if you really understand their thought processes, the suicide is a rational thing from their point of view. If I am to blame for all this, they figure, I don't deserve to live."

While the efforts of Stoves, Cantor and others have improved treatment, many remain in the disorder's deadly grasp.

"I rapid cycle, and when I am manic I am filled with rage and often don't remember clearly what I do," said Chilly, a 34-year-old man. "Then the guilt hits."

"Sometimes," he continued, "my mind races so much, the only way to slow it down is by cutting."

http://www.decaturdaily.com/decaturd.../bipolar.shtml
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