Opting In: Bipolar Disorder and the Vicious Cycle of Medication

I have written in the past about how I opt-in to sanity by taking my medication every day.

For me, this is an easy decision. I never again want to experience the depression I suffered with my whole life, nor do I want to go into mania and jeopardize everything I’ve worked so hard for. 

Regardless, I have sympathy for other bipolar patients who face this decision and opt-out of medication. 

In The Dickensian Reset, I wrote about how I found Lithium—the most commonly prescribed mood stabilizer—to be oppressive. I worked with my prescriber to wean myself off of it.

I also wrote about the different atypical antipsychotics I was prescribed. Some seemed to have no effect; some seemed to make me worse; others worked but still had debilitating side effects. For me, Abilify (generic Aripiprazole, really) is a miracle drug, but I can’t endorse it for everyone. Horror stories can readily be found online of those who took Abilify and had terrible side effects or abnormal behaviors.

However, I am also on a very low dose (5 mg/daily), whereas some of the stories I read involve dosages of hundreds of milligrams of Abilify or another antipsychotic. When I read those reports, I feel like the dosage alone explains their issue: of course these overmedicated patients are experiencing terrible side effects!

Quitting your medication cold turkey—while I can appreciate the temptation—isn’t the answer though. You’re bound to relapse and have another severe episode, likely leading to hospitalization, and then be put back onto your medication. To make matters worse, there is evidence that the more you go on these "medication vacations" the more difficult your symptoms become to manage. 

My advice to my fellow bipolar patients is to advocate for yourself rather than quitting your medication. Work with your prescriber to find a drug that works for you, but has the least side effects. Work to reduce your medication’s dosage until you find that balance of efficacy with little-to-no side effects.

Never give up hope, keep experimenting, and when you find a regimen that works for you, keep with it.

If you take a psychopharmaceutical, what has your journey been like?

Reflections on Self-Employment

On Thursday, April 7^th, 2005, in a fit of frustration with my employer, I started doodling on my yellow legal pad instead of paying attention in a late afternoon meeting.

Specifically, I was coming up with a brand name and logo for my own software development business. I’d had enough of working for the small mom-and-pop shop, and I felt I could make it out there on my own.

At the same time, my boss was starting to zero in on a particular line of business, and starting to ignore the customers who had got him to where he was. I knew all I'd have to do was scoop up some of the business he was turning away. I hadn’t signed a non-compete agreement, and I was entirely transparent about what I was doing. My boss even supported the effort, happy to have someone to refer his long-time clients to.

The business started as a side-hustle; I’d work my day job then come home to start my second shift. I was easily working over sixty hours a week.

Eventually, I had enough steady work coming in from multiple clients that I could take the leap and quit my day job.

Becoming an independent consultant meant I could work on client projects during the day, freeing up my evenings to work on products of my own design. To help stay focused on my own products, I committed to releasing minor updates of at least one free product each week as a way to slowly grow my intellectual property while also bringing in revenue to feed my family.

But it wasn’t all rosy. I quickly learned some hard facts about being your own boss. Not only was I in charge of producing the software, I also had to be sales rep, marketer, tech support, and accountant.

Another lesson I learned was that being in business for oneself means that you have to pay the bills first, and yourself second. While I my gross income broke six figures for the first time, I was bringing home the same meagre salary I had with my previous employer. I had to fully fund all of my benefits, which were more costly than I had anticipated. Taxes alone ate about 25% of my income.

I was humbled by the realities of managing a small business. I came to respect my previous employer on a deeper level.

But there was something to be said for the excitement of it all; I was flying by the seat of my pants and would enter into lucrative contracts where I didn’t know if I could deliver in time.

I look back on this period of high-risk, high-reward a bit in awe that I was able to accomplish as much as I did. I feel proud that I was able to support my growing family while going my own way—although it was a bit like walking a tightrope without a safety net. I had some scares along the way, but I continually brought home the bacon.

At the same time, looking back now through the lens of my diagnosis, I see something else: hypomania.

I was incredibly productive, but, honestly, the quality of my work wasn’t the best. I was self-confident to the point of arrogance: starting a small business requires incredible faith in oneself and the world. You almost have to be somewhat delusional to go for it.

Hypomanic or not, I reflect on that version of myself and almost envy the bravado.

Eventually, the business ended—a victim of the great recession. One of my clients offered me a job and, having newborn Hunter at home, I jumped at the opportunity.

I learned many lessons by being in business for myself; if nothing else, it has made me a more appreciative employee.

Today, I work for a Fortune 50 organization with over fifty thousand people on staff, the exact opposite of a sole proprietorship. There’s some safety in numbers, and distributing the work across that many people means we can deal with a volume of transactions that I couldn’t have imagined handling in the past. My team and I address software development problems that are more interesting exactly because of their scale. I’m happier now than I ever was working on my own.

 What size company fits you best?

Self-Identification of Bipolar Disability

At my employer, we are asked annually to fill out “self-identification” forms. The company wants to see if any their employees identify as LGBTQIA+, as veteran, or as disabled. Questions like these often appear on application forms and new hire paperwork as well.

The data collected allow the company assess itself on how it is meeting DEI goals. The federal government here in the US has a goal that 7% of its workforce, and the workforce of any company it contracts with, are individuals with disabilities.

The last time I was asked to fill out these forms, I noticed that bipolar disorder is on the list of recognized disabilities.

While I accept that I was certainly disabled during my manic episode, I don’t feel disabled today, despite my diagnosis. Currently, the only impact bipolar disorder has on my life is in taking my medication once a day, and obviously I hope it remains that way.

Still, I feel conflicted here. Self-identification may help my employer towards their goal. On the other hand, if they decided to audit these self-identification forms and questioned what disability I had, I’d be forced to disclose to my diagnosis to my employer, and while they couldn’t terminate me for having the condition, they could certainly limit my career growth.

There is a third option, which is to not answer the question at all, but then I feel that I would be viewed as someone who is either being intentionally uncooperative. 

To be clear, I know that not everyone with bipolar disorder is as fortunate as I am; there are folks who are truly disabled by this condition. I fully support bipolar disorder being a federally recognized disability.

But for me? No, I don’t feel disabled. I’m still able to bring my talents to bear for my employer. I do not require any special accommodations or concessions.

I’m just me.

What option would you choose?

West Energy Wisdom

In The Dickensian Reset, I talk about the art that was left behind by earlier patients, in particular, the piece pictured below, which was titled West Energy Wisdom.

While the revised versions contain the below image on the back cover, I felt it would be helpful to share here for readers of the Kindle edition.

There is a saying in Zen:

    Before enlightenment,
        mountains are mountains and rivers are rivers.

    During enlightenment,
        mountains are no longer mountains and rivers are no longer rivers.

    After enlightenment,
        mountains are once again mountains and rivers are once again rivers.

The above image reminds me of this quote, both for its depictions of mountains and rivers, but also for another reason as well.

When I first saw this image upon my first entrance to my room, I saw just a childish scribble. It inspired me to begin writing a sarcastic journal entry about the "mad house art." But as I studied the image, I became enthralled by its beauty: not for the technical skill of the artist, but for what they were able to convey with such limited materials. I found the image incredibly peaceful.

I was impressed by the artwork's accuracy in details, from rivers starting at mountains to the rendering of the moon, which is correctly lit on the proper side by the setting sun.

Moreover, it features many small vignettes:

• Two deer stand on the banks of a river; one of them has their head down, drinking from the cool waters.
• Downstream, a tree has fallen into the river and made a natural dam; salmon are jumping over the log.
• A mother bear works to pull down a beehive; nearby her cubs wait patiently.
• The river ends at a waterfall that feeds a large lake; swimming in its clear waters are two massive koi.
• On a dock, extending into the river, a man in a straw hat fishes, perhaps in hopes of catching those two kings of the lake; his loyal dog sits nearby panting.

These scenes drew me into the painting. I could almost feel what it would be like to be sitting on that dock, fishing, gazing into that forest teaming with life; you can imagine how much more I appreciated that feeling of peace while I was confined. 

Now, today, while I can still appreciate the image with the same perspective I had while in mania, I also see it simply for what it is, some crayon on a wall. I can appreciate that my mania caused me to see everything as significant, including this work of art, and it was just some graffiti left behind by a former patient.

What do you see? What other things become more beautiful the longer you look at them?

Now Available: Expanded Hardcover Edition

Part of the reason I've been so busy editing The Dickensian Reset lately was so that I could re-release it as a hardcover edition.

In the book, I refer to many of my journal entries and poems I wrote while in the psych ward—poems that I felt at the time were practically scripture. 

The hardcover edition includes as, an appendix, these journal entries and poetry. Doing so gives the reader a deeper glimpse into my madness, and allows one to flip back and forth between the text and the journal entries, if desired. It's about 60 pages of additional content. 

The best part is, it's only marginally more expensive than the paperback version.

Get yours here:

Still Editing, One Year Later

About a year after the original release of The Dickensian Reset, I decided to share it with a close friend of mine who is going through his own medical scare lately. 

I decided to re-read the text with fresh eyes, and found a number of issues in the original text. I spent the last month re-editing the book, and finally got my perfect read.

These edits included:

• Adding missing words
• Changing repeated words
• Improved punctuation
• changing some dashes and semicolons to colons where applicable
• standardizing the exclaimed question punctuation to !?
• Breaking quotes into their own paragraphs (in most cases)
• Clarifying who was speaking (on occasion)

While most of these changes do not impact the overall story, they do improve the general quality of the work.

The newly revised edition is now available on Amazon.  I sent updated copies to Phoebe and my friend; I also (finally) sent a copy to the Library of Congress, which I was supposed to do months ago after I received my LCCN.

I also sent the updated editions to NYT and NPR. While I hope they will review the book, it's just as likely that it just gets thrown immediately in the trash heap since it is self-published; but, as the saying goes, you have to be in it to win it.

It Is Done

Today I finally published my first book on Amazon!

The Dickensian Reset is currently available on the kindle store. Before I start promoting this, I'm waiting for the paperback version to be approved. 

It's been a few months of effort, but I'm excited to finally be at the next phase of the journey.