by Sheila Marie LaPolla

In June of 1993, I was diagnosed with bipolar disorder. I was shocked. I couldn't believe it. I didn't believe it. It took a long time for me to accept my manic depressive illness.

The thought of having a mental illness disturbed me deeply. I grieved. I cried. I understood the stages of classic grieving initial shock, negotiation, anger and, ultimately, acceptance. I had been diagnosed with a metabolic disorder, insulin dependent diabetes mellitus, at the age of thirty eight. Like bipolar disorder, it is a chronic disease that can be controlled but not cured. It, too, is a chronic disease that can have devastating consequences without appropriate treatment. Now, at fortytwo, I was told I had a neurobiological disorder manic depressive illness. I had a mood disorder that affected my psychological as well as my physical state of being. It was too much for me to bear, and I went into denial for a long time.

I grew up in a family riveted with mental illness. My father was consumed by depression and alcoholism, often attempting suicide as he traveled through the revolving door in and out of mental institutions. No one ever explained my father's illness to me. I equated it with weakness. I now know he had a neurobiological disorder. He had severe unipolar depression, and he died a victim of his diseases.

At nineteen, my brother Roger was diagnosed with paranoid schizophrenia. He withdrew from life and lived a hell I've never known. He, too, was in and out of mental institutions. His health deteriorated and he died at age thirty nine.

At twenty, my brother Paul was diagnosed with bipolar disorder. He had dual conditions for he, like my father, was an alcoholic. He lived the fast life, but was also in and out of institutions. In July of 1993, a month after my diagnosis, he committed suicide at forty one.
Mental illness had taken its toll of my family and now the doctors were telling me I, too, had a mental illness. I refused to believe it. I was too strong to succumb to such an illness. I would not give in to the emotions tearing me apart. Having witnessed the horrors visited on my father and two brothers the slow torture that led to their deaths deep in the recesses of my mind I feared the same fate... that of a helpless victim.

Still, at the core of me, was the experience of being a survivor; I had always beaten the odds. I grew up in a roach infested New York project, on the wrong side of the tracks, in a dysfunctional family. Of five siblings,

I was the only one who graduated from high school, then went on to college and a master's degree. I became an elementary school teacher then a consultant to a California state Senator. Surely I had the character to beat the odds again.

But things did not get better; they got worse. I couldn't believe what was happening to me. I was losing control. My confidence was shaken. I could no longer trust my judgment. I was impulsive, unstable and labile I would laugh and cry almost simultaneously. It seemed I was manic and depressed at the same time; a curious phenomenon.

My psychiatrist said I had a mixed state bipolar disorder. I rationalized that I was always emotional. I was a dramatic individual going through an extraordinarily stressful period in my life. I could not distinguish the disease from me from who I was.

I desperately needed to understand what was happening to me. I was supercharged. I experienced intense psychomotor agitation and was immersed in a sea of irritability. I experienced an exaggerated startle response and jumped at the slightest noise; a slice of toast popping up, a phone ring, a gentle voice. I was bombarded with stimuli. I constantly forgot and lost things. Gone were the days of self assurance. I didn't know what to expect. I stuttered for the first time in my life. It was as if I got stuck on a word... a concept... while a whole story was whirling in my mind, urgently trying to get out. Hundreds of sentences lined up, scrambling, trapped. My thoughts raced. My speech came faster and faster. I could see the look in people's eyes, but I couldn't slow down.

I could not sleep. I could not stop thinking. My thoughts ricocheted inside my head. I could not hold on to a single thought; everything distracted me. If I held on to a thought, I was obsessed with it, as if it were some pearl of wisdom. And, if I tried to jot it down, ten more thoughts fought for my attention. Soon I had ten attache cases full of hundreds of notes on scraps of paper.

I discussed them with my therapist and he helped me understand my whirlwind of thinking. Tears saturated my being. I was in an emotional turmoil, and I remember the time my brother, Paul, called out to me, "Sheila, 1 know who I am! I am Ali Baba! I am a purple bird! I am Yah, flame of fire!"

He was crazy, not me, I told myself. He was manic depressive, not me. I knew who I was. Besides, I never considered suicide. I wanted sleep, not death. Yet, once a strange feeling did possess me, just for a split second... and I did think, "Just one shot (insulin overdose) and all this will end!"

I researched the literature and came across the diagnostic criteria for a manic
I desperately needed to understand what was happening tome. I was supercharged. I experienced intense psychomotor agitation and was immersed in a sea of irritability.
episode. I could no longer deny I had a manic episode.

It took many hours of therapy for me to even entertain the thought of having bipolar disorder. Once I did, I had another hurdle to overcome my husband's acceptance.

"You're not like your brother! Those damn doctors just want your money!" he shouted as his fist pierced the wall. My son, too, thought my diagnosis was "absolutely absurd!" I was not only fighting my acceptance. I was fighting theirs.

My brother, Paul, phoned from out of town. I knew he was in trouble. I didn't know how much trouble. "...I am... hypermanic... incoherent, unstoppable, straight jacket material..." My heart ached as I could do no more than listen. If only my love for him could cure him.

He called again and again over the next couple weeks. "The first point is not the last... I feel like a Viking ready to conquer the world! Yah! A, B, C... look out X Y Z!"

Then, one day, he was making some sense.
"Paul, you're not thinking suicide?" I asked.
" "
No.

"Because I remember you told me you thought of suicide after you had an episode..."

"Sheila, I'm a young man. I have my whole life ahead of me."

I can still hear his voice. What happened between that last phone call and ten days later, I'll never know. The sheriff said it was a self inflicted gunshot wound. My brother was dead. I had thought there was hope of recovery for him but, instead, he ended his life. In the throes of my own bipolar disorder for less than a month, I was experiencing what the devastation of it could be. My brother was dead.

I was already in a fragile state of mind and his death added to my emotional upheaval. I needed to trust my doctors, stop self medicating with alcohol and take my prescribed medications. The side effects were almost intolerable, but I acquiesced. The feeling of sedation was uncomfortable, but at least I wasn't whipped around between highs and lows as often. I had some equilibrium.

I needed to accept that I was vulnerable. It was difficult. It did not fit the image I had of myself. I was going through an identity crisis losing control yet not wanting to give up the little control I still had. My life took dramatic twists and turns. I fell victim to my whims. Without restraint, I would be off on a spree using my credit card as a magic carpet. My emotions ran wild. I was flirtatious and seductive. I did not recognize my judgment was impaired until I experienced a crisis. I desperately needed help.

My doctors frequently used the term "fragile" to describe my condition. I was volatile. My moods were exaggerated even with medication. I was not functioning well at home or at work. I struggled with my emotions and focused my energies on trying to maintain equilibrium.

The intense stress I was experiencing caused havoc with my diabetes control. Insulin dependent diabetes requires delicate balancing of hormones, insulin, diet and exercise to keep a person's blood sugar level within normal range. During my manic phase I was incapable of keeping the necessary detailed records of my daily regimen of four shots. My blood sugar level swung from high to dangerously low, much like my moods did. Insulin dependent diabetes and acute manic depression are a dangerous duo.

Control of my bipolar disorder proved difficult. I was treated with a sedative (Restoril), an anti anxiety drug (Klonopin), and an anti manic, anticonvulsant (Depakote). I responded to their mood stabilizing effects, but was still symptomatic. I experienced distressing side effects; persistent hair loss, weight gain, sedation, influenzalike symptoms and memory loss.

Unhappy with the side effects and the feeling of dependency, I convinced myself that I did not need therapeutic medications. So, I stopped taking them, believing I had the inner strength to overcome my illness. After very little sleep for days, I gave in to taking a sedative. I was jarred out of a drugged sleep the next morning. It was my psychiatrist.

"You are risking disaster!"

I believed him. Yet, months later I quit taking my meds again. Mania reappeared. Patiently, my psychiatrist reminded me that I had a biochemical disease that was physiological, not psychological, even though it had psychological ramifications. I had a neurological disorder that required medical treatment just as my hormonal disorder required medical treatment. I needed to accept responsibility for its management.

In weekly psychotherapy sessions I developed a close therapeutic relationship with my counselor. In the midst of a pervasive pessimism, he assured me that I would survive the trauma I was enduring if I dared to be optimistic. He insisted, however, that I follow my psychiatrist's admonition to stop drinking alcohol. He helped me recognize that my abnormal behavior was a manifestation of my bipolar disorder, and with his insightful counseling I began to accept the illness and to cope with its mind altering nature.

Eventually, my psychiatrist decided to treat me with an anti psychotic medication (Risperdal). It frightened me. "I'm manic, not psychotic! Why do I need an anti psychotic drug?"

My doctor allayed my fears. Within a week I noticed a change. It was as if a thin veil had lifted, all haziness disappeared and my thoughts were no longer clouded. I felt stable. I felt hope. And, as time went by, the pieces of my former self emerged. I knew I would make it! And that is the most incredible feeling of all.

It has taken two years of treatment and great determination to achieve near normalcy. My psychiatrist tells me that I am not in complete remission. My therapist agrees with that evaluation. I, too, recognize that I am still vulnerable to the disease's intrusive nature. I remember the day I announced to my therapist that I was better. "Better managed!" he reminded me. It was an important distinction for me. I do know I am not cured.

But, I feel well! And that feels so good! I'm still a very dramatic person, still emotional; but those characteristics are a part of my normalcy. I am confident once again, and optimistic about the future. Still at risk, I know I am resilient. I am a survivor!

(This article was first pubished in 1995, in The Journal of NAMI California

SHEILA MARIE LA POLLA is a former school teacher who now works as a consultant to a California State Senator.