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Abstract:
This is Part 2 of a 140,000 word (350 page font-14) longitudinal, retrospective and prospective account of my experience with bipolar disorder and some other mental health problems over 72 years:October 1943 to March 2016.
Notes:
This is a personal and idiosyncratic, medical and clinical study of what some life-study students call a chaos narrative. This study focuses on an aspect of my life involving several mental health issues, mainly bipolar 1 disorder. This account is now in its 16th edition. In my retirement, the years from 2001 to 2016, I have revised the account each year. This book has 15 chapters; the last chapter contains ten appendices.

This is Part 2 of a Two-Part account here at Baha'i Library Online. This account, this Part 2 begins when I went on lithium at the age of 35 in May 1980, and takes readers to the present, to the age of 71 in March 2016.


Account of 72 Years of My Experience With Bipolar 1 Disorder: Part 2:
A Personal-Clinical Study: A Chaos Narrative

by Ron Price

2014

Account of 72 Years of My Experience With Bipolar Disorder: A Personal-Clinical Study of A Chaos Narrative by Ron Price

FOREWORD

Part 2:

Section 1:

Part 1 of this now lengthy book took readers from my conception in October 1943 to May-July 1980 when I was 36, the half-way point in my 72 years of living. Go to this link at BLO to access that Part 1: http://bahai-library.com/price_mental-health_history_autobiography-memoir. Below readers will find Part 2 of a 140,000 word(350 page, font-14; 400 pages-font 16) longitudinal, retrospective & prospective account of my experience with bipolar disorder, as well as several other mental health problems over 72 years: from October 1943 to March. 2016. This is a personal, clinical, and idiosyncratic study of what some life-study students call a chaos narrative. This study focuses on an aspect of my life involving several mental health issues, but mainly bipolar 1 disorder. This account is now in the st draft of its 16th edition. In my retirement, beginning in the first year of the 3rd millennium, that is 2001, I have revised the account each year to:(i) add the changes in my medications and life experience, and (ii) update the information base over the 72 years as information about BPD became available in cyberspace.

In his book "The Interpretation of Dreams" Sigmund Freud wrote that, “creative writers are valuable allies and their evidence is to be prized highly. This is because such people are apt to know of a whole host of things between heaven and earth of which our philosophy has not yet let us dream. In their knowledge of the mind, they are far in advance of us everyday people”(1962, p. 8). As a creative writer I strive in this account for as much relevant inclusivity as possible, and a greater understanding of the power of cultural construction and narrative. For the most part, though, this account aims more at clinical and medical, factual and scientific analysis not creative narrative construction.

This account, now a book of many hundreds of pages, is not written as a narrative with episodes to keep readers wanting to read more, like a novel. It is not written to be an interesting, highly personal account, for publishers to market and achieve a big readership. This account is, as I say above, a book with clinical, medical, scientific, factually specific, longitudinal and, for most readers, a quite antiseptic diagnosis and description of my experience. It is not a story to keep readers on the edge of their seats. It is written to be of help to those with an interest in this particular mental health problem, bi-polar disorder, and it is written to provide a life-narrative, one person's life experience, now some 72 years, in dealing with the manifestations of several mental health issues in his life.

Section 2:

Part 1:

The field of medicine will, for the foreseeable future, not be 100% precise; there is certainly room for greatly enhancing clinical practice through the prediction of outcomes based on the tools of genomics and other -omics, such as transcriptomics, proteomics, lipidomics, and metabolomics. At present, in psychiatry the efficacy of each treatment cannot be predicted. As is the case in all of medicine, patients tend to respond to some but not all treatments and typically have an adverse drug reaction (ADR) profile that varies from drug to drug, some being well tolerated and others not. The outcomes of treatment with the same drug, administered for what appear to be similar clinical presentations that are grouped together under the same DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) diagnosis, may vary widely, from full remission without significant ADRs to lack of response or partial response with or without ADRs. Clinically, the most challenging outcomes consist of a partial clinical response with moderate side effects. The decision as to whether to stop or modify treatment, and to what degree, can result in either clinical improvement or deterioration and relapse. Such decisions are currently made in an uninformed manner, with no tools or markers of outcomes that can be used as a guide.

Psychotropic drugs are among the best-selling drug classes. These drugs includes antipsychotics and antidepressants, the latter being the second most prescribed drug class in the United States. The most prescribed class is analgesics which includes over-the-counter products such as aspirin and acetaminophen. Therefore, of prescribed drug classes, antidepressants are the top sellers: 11% of the US population over 12 years of age is on antidepressants. It is just not acceptable in the light of existing technologies.A major effort should be made to identify and validate markers that would enable clinicians to target specific treatments on an individual basis. Without using any new products, psychiatric treatment would be greatly enhanced if we could use existing medications in conjunction with tools to predict positive response as well as ADRs. A major roadblock for pharmacogenomics is cost. Readers with the interest should follow-up on this line of thought.

BPD can be treated much like the other tests and struggles of life. If responded to wisely, BPD can become an opportunity for spiritual development. Unfortunately, by defining BPD as an acceptable form of human neurodiversity, BPD, the spiritual test, has been turned into BPD, as a moral ideal. I consider BPD to be no more than a different way of being. For those who suffer from BPD some of the helpful therapies appear to be music therapy (an audio discussion), such as sensory stimulation and improved emotional communication. Music therapy, which often involves sound in general, is an allied health profession and one of the creative arts, or expressive, therapies. Other approaches within this field are writing (including poetry), drama (psychodrama, sociodrama, puppet therapy, etc.), dance/movement (with Authentic Movement and Expressive Movement Processing), and art therapies.

Part 2:

Diagnosis will greatly benefit from further research. In order for knowledge to be advanced in the field of psychiatry, a classification system must exist to group patients based on defining characteristics. Existing classifications, such as the International Classification of Diseases (ICD)-10 and the DSM-5, (ref. 11) are still conceptually based on decades-old recommendations from the World Health Organization (WHO) for an atheoretical classification based entirely on descriptively grouping clusters of symptoms.12 Whereas the WHO recommendation was specific for epidemiological studies, both ICD-10 and DSM-IV and 5 have been extensively used for clinical diagnostic purposes, for health insurance and reimbursement, and to guide research. As modern medicine has evolved since 1959, it has become evident that the same causal mechanisms can result in diverse clinical presentations, and different groups of contributing factors can result in similar presentations. It is highly likely that clusters of symptoms—for example, the ones we now know as major depression, bipolar disorder, and schizophrenia—will ultimately prove to be final common manifestations of diverse groupings of causal factors. Conversely, it is expected that the same variants of genes relevant to brain function will, in different individuals, result in different types of clinical presentations.

Part 2.1:

Psychiatric medication, or psychotropics, are increasingly prescribed for people of all ages by both psychiatry and primary care doctors for a multitude of mental health and/or behavioral disorders, creating a sharp rise in polypharmacy (i.e., multiple medications). The clinical reality of modern psychotropy at the level of the prescribing doctor and clinical exchanges with patients has become more and more complex. There are what you might call geographies of high prescribing(GHP). There are several types of factors (pharmaceutical-promotional, historical, cultural, etc.) that can shape specific psychotropic landscapes. Ethnographic attention is now focused on high prescribing in Japan in the 1990s and more recently in parts of of Michigan in the US. These examples help to identify factors that have converged over time to produce specific kinds of branded psychotropic profiles in specific locales. There is now a new kind of clinical work being carried out by pharmaceutically conscious doctors which reduces the number of medications being prescribed to patients while re-diagnosing their mental illnesses. A high-prescribing psychiatrist in southeast Wisconsin is highlighted to illustrate a kind of med-checking taking place at the level of individual patients. These various examples and cases call for a renewed emphasis by anthropology to critically examine the “total efficacies” of modern pharmaceuticals and to continue to disaggregate mental illness categories in the Boasian tradition. This will require a holistic approach, incorporating emergent fields such as neuroanthropology and other kinds of creative collaborations. At this point in time I can see no relevance to my BPD of this study of specific psychotropic landscapes.

PSYCHIATRY-A BRIEF HISTORY:1700 to 2000

Part 1:

Modern psychiatry began in the 18th century, with the reconceptualization of madness as a disease & not the result of witchcraft or demonic possession. This new idea led to dramatic successes, such as the delineation of syphilitic infection as a cause of general paresis, and more is expected in the near future as we unravel the genetics and neurobiology of schizophrenia and bipolar disease. It also led to the growing use of a medical model in psychiatric practice, with disease categories, diagnoses, & disease-specific therapies. A second, and in many respects competing, idea formulates problems of character, personality, and adaptation to the stresses of life as understandable and treatable psychological patterns rather than moral weaknesses or the inevitability of the human condition. This view was tied to medicine and psychiatry by Sigmund Freud and his psychoanalytic followers.

Good relationships and communication between doctors and patient based upon empathy, compassion, respect, and competence are vital to providing better quality care. Recognizing and acting upon this within the different branches of our health-care system is critical if we wish to avoid experiencing the very troubling dysfunction that is often present in all branches of medicine. Looking back over decades of experience of psychiatric and non-psychiatric medicine, I feel I have been, for the most part, in good hands. I recommend to readers here, though, a book entitled "Internal Medicine: A Doctor’s Stories" by Terrence Holt. Each exquisitely crafted and evocative tale reveals not only the power of Holt’s storytelling, but the stark realization that for doctors and patients alike, it’s our bodies that “remain the essential mystery we keep trying to solve.” My body has certainly presented an essential mystery to me all my life, and this book, this account of my experience of BPD, attempts to show how I have tried to deal with this mystery and its reality in my experience of my lifespan.

Part 2:

The work of psychiatry has always revolved around the twin imperatives of care & custody.In an older model of psychiatric power, coercion and confinement were accomplished through isolation from society. The asylum became the ultimate symbol of such power. It arose in the long historical process Foucault termed "the great confinement;" it reached its ultimate expression in the "total institution" exposed by Goffman in the mid-20th Century. As the landscape of mental health shifted, anthropological attention turned away from the asylum to focus on other topics: psychiatry’s contribution to social control in the neo-liberal state, as practices of governmentality (Foucault 2012), new technologies of the self (Rose 1996) and pharmaceuticalization, and the global health movement (Biehl and Joa˜o 2011)

Constraint nevertheless remains a common practice even in our post-asylum era. The special section of the online journal "Culture, Medicine, and Psychiatry" examines contemporary tactics of psychiatric constraint through studies of mental health settings in the USA and France. The four papers connect abstract arguments about disorder, ethics, and subjectivity to the rough edge of practice, where the interests of clinicians and patients most sharply diverge. The mandate not only to treat people but also to control them has produced diverse practices of constraint and on-going struggles about their legitimacy. The authors here take up constraint as a therapeutic value, social logic, work routine, and a challenge to the moral self-regard of front-line clinicians. Readers with an interest in this topic should read: "The Practice of Constraint in Psychiatry: Emergent Forms of Care and Control" by Paul Brodwin & Livia Velpry in the online journal Culture, Medicine and Psychiatry(2014, Vol.38).

Part 3:

Psychiatry uses confinement as part of its evolving mandate over suffering individuals with violent behavior. This was true in relation to my confinement in 1968 in a mental hospital and the psychiatric clinic of a hospital, and in 1980 in the psychiatric clinic of a hospital. Although historically the epicenter of secure psychiatric care for dangerous individuals shifted from the asylum to the prison and the hospital, a review of public reports and the psychiatric literature demonstrates that psychiatrists have reclaimed confinement as part of their therapeutic practice. Institutional-level analysis emphasizes psychiatry’s enduring concern to subordinate social defense motives to a therapeutic rationale. Professionals justify a security-driven policy that prevents psychiatrists from defending a genuine therapeutic justification for confinement. Professionals differentiate their concern for access to care and human dignity on the one hand to their desire to defend the need for protection and safety from potentially dangerous patients on the other. This process reveals the difficulty of defining confinement practices as care when autonomy is a core social value. This is not and was not a concern for me, but it is a concern for many as they try to understand the world of mental health.

CHAOS NARRATIVE NOT CONVERSION NARRATIVE

Mine is a chaos narrative not a conversion narrative. As treatments for disorders and malignancies, illnesses and medical problems of all sorts have improved incrementally in preceding decades, sufferers are often encouraged to reject an attitude of hopelessness and to choose instead the role of fighters. The recasting of the patient as warrior a winner, upheld through the Livestrong movement, reaches a monstrous apotheosis in many forms in today's world. The story of some individual often begins with the sufferer as the protagonist, but the arc of their conversion narrative transforms them into the antagonist, exploring the darkest potential of a post-diagnosis empowerment. Their awareness of their own problem, or even in some cases their possible mortality, enables them to take risks that their more rational, pre-diagnostic-self would have avoided. Rather than being rendered impotent by their symptoms, and possibly by their fear of an impending death, they find themselves emboldened, liberated from behavioral norms, capable of heretofore-unthinkable behaviours.

I am aware of this aspect of my experience especially in recent years. Such individuals move from victim to victor. Observers of these people often come to realize the perils of this survive-at-all-costs mentality. Observers are forced to question their own, initially sympathetic, perception of the person in question. The notion of the patient made noble through struggle gradually changes into a notion of the patient betrayed by their own body and experience. Observers come to see a patient willing to betray everything else in the amoral service of their pride. This is something that is important for me to be aware of in the sense that I do not hide behind my disorder and use it as an excuse for whatever behaviour I want to justify for some reason or other.

NARRATIVE:MEANING AND METAPHOR

Narrative is simply how human brains like to think, arranging apparently random and thus possibly disturbing and meaningless events into patterns which reveal a purpose or move towards a resolution. Narrative as applied to illness creates the central character as winner, loser, or survivor, as hero or as villain. In this narrative, this account, of my bipolar disorder, I am the central character. John Green’s (2012) novel about young cancer patients, "The Fault in Our Stars", opens with an ‘Author’s note’ on the power, and indeed the necessity, of narrative: "This is not so much an author’s note," writes Green, "as an author’s reminder of what was printed in small type a few pages ago: This book is a work of fiction. I made it up." Neither novels nor their readers, though, benefit from attempts to see the story as a set of hidden facts inside a story. Such views of stories as hiding the true facts attack the very idea that made-up stories can matter, which is sort of the foundational assumption of our species. This need for narrative applies to the stories we tell to ourselves as much as to those we read or see. In "The Fault in Our Stars", Hazel—as a young girl with a very uncertain future—is delighted to enjoy reading a novel that turns out to be the first in a long series, commenting ‘it was exciting to live again in an infinite fiction’ (Green 2012, p. 46). I leave this concept of the role of fiction in healing with readers who have the interest.

My interest here is in the concept of the telling of one's story as an attempt to define a coherent self. Illness, whether it affects our bodies or our minds, can challenge our sense of a coherent self, and when this happens the sufferer often needs to retell their story to incorporate new material while keeping a sense of progress: ideally, ‘living happily ever after’. This is certainly the case with me as I write this account of my expereicne of bipolar disorder among other mental health issues. Close reading, perhaps the methodology most central to the humanities, is also fundamental to narrative medicine, as well as recalling the attention to reading the signs of the body that has been part of medicine since the Hippocratic corpus. My work here is part and parcel of this field of narrative medicine and I do this narrativeizing in my own personal modus operandi.

There are many aspects to narrative medicine and its place in health care today: (i) there is a range of metaphors available to patients and physicians; (ii) there is the notion of the morality of disability; (iii) there is the story of survivorship and alternatives to it; (iv) there is the role of dreams and what they have been thought to show about the relative powers of the mind and the body; and, above all, (v) there are ways in which specific genres within film, television, and literature have addressed disability and illness. As is now recognised, medicine has always drawn on a range of powerful images to explore the experiences of disability, illness, and healing. For much of western history, storms and shipwreck have been particularly potent metaphors and, more recently, so have the metaphors of battle and war.

BIG PHARMA

Part 1:

FDA-approved pharmaceuticals should not be considered revolutionary but, rather, they should simply be seen as a different set of tools for altering our moods and behaviors. Therefore, we need to dampen both our enthusiasm and apocalyptic fears of big pharma: SSRIs, stimulants, and sedatives are simply another cultural form in the service of normalizing behavior and making people feel better by first naming a disease and then delineating a course of action. We need to move beyond castigating global pharmaceutical markets not because there are not tremendous problems with overprescribing, dependence, and overdosing, but because we need to focus on analytic frames that help us unpack why these marginally efficacious drugs are in such high demand. The link between pathophysiology and mental health is culturally elaborated. Simply removing psychoactive drugs from the marketplace is not a solution. We have come to rely on them because other institutional and familial support systems do not exist or are not equipped to handle abnormal behavior. Difference is not something many people in industrialized countries accept, and therefore without psychopharmaceuticals, many patients would feel at a loss for how to deal with their addictions, anxieties, alienation, or abnormal compulsions. t treating mental illness may not require expensive medical treatments with limited efficacy. Social investments that expand our definition of normal behavior and that integrate people with cognitive differences into communities may be expensive as well, but at least, these approaches produce better outcomes.

I do not want to skirt-around the issue of big pharma. As i say above, simply removing psychoactive drugs from the marketplace, and seeking out alternatives, is not a solution for me, although it may be for some others. I have come to rely on pharmacotherapy for several reasons which I explain throughout this book. Other institutional and familial support systems do not exist or are not equipped to handle whatever abnormal behavior I exhibit, or have exhibited in the more than 50 years during which I have exhibited BPD symptoms. Difference is not something many people in industrialized countries accept and, if they accept it it is usually only in theory. In practice most people have a clear limit on what they can deal with in interpersonal interaction. Therefore without psychopharmaceuticals, many patients would feel at a loss for how to deal with their addictions and anxieties, alienation and abnormal compulsions. Overmedication has, I believe, reached its peak in many countries. But, as far as I am concerned, I am not over-medicating.

Part 2:

There exists a generation of people in Western society, of whom I am a member, who think that any fear, sadness,or anxiety means that there is something wrong that requires a drug. How do we renormalize psychic distress and even declining mental health in old age? I am now 71 and I have serious doubts about the capacity of my society to renormalize me without what have been for me very helpful medications over many decades. The hopeful take-away message from many papers I have read is that treating mental illness may not require medic-pharmacological treatments with known limited efficacy. Social investments that expand the social definition of normal behavior and that integrate people with cognitive differences into communities are often expensive. These approaches often produce better outcomes, but I am not prepared to take the risk.

Psychopharmaceuticals have become a common means to treat mental distress in diverse contexts around the globe. In the past 20 years, 1994 to 2014, since I became fully compliant on the medications for my BPD, after a decade or more of non-compliance or only partial compliance, there has been an escalating global influence of biomedicine. This has led to the increasing presence of psycho-pharmaceuticals in many industrialized countries. Psychiatric drugs represent a multi-billion-dollar-a-year industry that promises to alleviate suffering and, as part of the global economy, these drugs have transformed the human sense of identity, agency, and affliction. While psychopharmaceutical interventions hold powerful promise for improving psychopathology, I am more than a little aware that assessments of their successes or failures are ambiguous. Psychopharmaceutical treatments are not “magic bullet” cures, and each drug has multiple, potentially competing effects. But, after all these years I find these magic bullets wonderful adjuncts to my daily life.

BIOMEDICAL VS PSYCHODYNAMIC MODELS OF PSYCHIATRY

Part 1:

Tanya Luhrmann's "Of Two Minds: The Growing Disorder in American Psychiatry"(2000)conceptualizes the moral and philosophical implications of the two currently competing models of illness and treatment. Luhrmann describes, and analyzes, two competing models of illness and treatment in psychiatry—the biomedical and the psychodynamic. She claims neutrality in the dispute, stating that she believes both approaches are "substantially correct and equally effective although not always for the same person." Luhrmann states as a fact, without reference, that “the available evidence we have suggests that for most patients and for most disorders, psychopharmacology and psychotherapy work best in combination.” However, there is no such evidence. Certainly, many patients do well with this combination, but for even more, particularly those with major psychoses, it has been difficult to demonstrate that psychotherapy offers more than sensitive, humane concern.

Psychotherapy is therapy in which a person with mental or emotional problems talks with another person. Sometimes this is called a talking therapy. This other person may be a psychiatrist, psychologist, counselor, clinical social worker, member of the clergy, alternative practitioner or, to use the concept in its broadest sense, any helpful person. With successful psychotherapy, a client experiences positive change, resolves or mitigates troublesome behaviors, beliefs, compulsions, thoughts, or emotions. Ideally, these are replaced with more pleasant and functional alternatives. The Primal Scream. Primal Therapy: The Cure for Neurosis is a 1970 book by Arthur Janov, the inventor of Primal therapy. The book was published just before I left Canada as an international pioneer-traveller for the Canadian Bahá'í community. Janov describes the experiences he had with 63 patients during his first 18 months, starting in 1967, discovering and practicing Primal therapy. He claims a 100% cure rate. The Primal Scream has been called "incredibly popular". It was read by tens of thousands of people and brought Janov fame and popular success. This inspired many therapists who had not met Janov to start offering imitation primal therapy, and led to the proliferation of programs offering happiness through radical personal transformation. In my 71 years I have never taken part in any form of psychotherapy.

The neurobiologic revolution and managed care provide the rhetoric for the “new” psychiatry, whereas psychoanalysis has become the symbol of the past. Luhrmann captures the experience of traditional students encountering this conflict as they enter the field. We must still await the anthropologic, sociological, and historical analyses that will help us understand where we are and how we got here and that will help us plan how to proceed. Luhrmann sees the biomedical and psychodynamic approaches as almost incompatible, at least to the psychiatric residents being asked to learn them, because of very basic differences when they are seen as "ideals." Her argument is that psychodynamic psychotherapy holds patients responsible for their actions, whereas the biomedical view, which regards psychiatric disorders as illnesses and patients as victims, does not. At the very end of her book readers are given a choice between understanding patients "only as the detritus of a broken brain" or as "engaged in the struggle to be decent, responsible people." If we choose the former, "the loss of our soul is a high price to pay." In other words, the biologically minded psychiatrist falls into this great moral loophole, even when treating patients humanely, if he or she "constructs" the patient as an incapacitated victim of illness.

Part 2:

Self-management of mental illness is a therapeutic paradigm that has gained an increasing foothold in the mass culture of western society in the last 10 to 20 years, since the 1990s. It is a mass culture I have been part of in many different ways for seven decades. The self-management discourse posits a stable and rational patient or consumer who can observe, anticipate, and preside over his or her disease through a set of learned practices. But in the case of bipolar disorder, this rationality of the patient is called into question; the very meaning of the managing-self is elusive, and the disease that is managed coincides with the self and all its idiosyncrasies. Biology is the great moral loophole of our age. It provides a moral vision that treats the body as choiceless and nonresponsible. That same vision sees the mind as choice-making and responsible and this has significant consequences for a view of mental illness precariously perched between the two models.

Nikolas Rose, in his book The Psychiatric Gaze, 1999, remarks that biomedical models have the potential to “open that which was considered natural to a form of choice.” (p. 37). Rose argues that techniques of medical self-control help constitute the free embodied liberal subject who is obliged to calculate and choose. Through an examination of the now vast clinical literature, as well as some of the practices and narratives in psychiatry one of the papers I read explored ethnographically the possibilities for subjectivity and agency in the self-management paradigm. This paradigm seems to simultaneously confer and deny rational self-hood to bipolar patients. To express their expertise as rational self-managers, patients or consumers must, paradoxically, articulate constant suspicion toward their present thoughts and emotions, and also articulate a distrust of their imagined future self. From my point of view self-management practices of my bipolar disorder model only provisional and distributed forms of agency. These forms are based on an elusive, discontinuous, and only partially knowable or controllable self. These forms also reveal, or so it seems to me, the limits of the contemporary medicalization of both selfhood and disease. This subject is quite complex and I hope to return to it in the months and years ahead as I continue to explore this elusive and complex mental health issue.

THE NEUROMOLECULAR GAZE

Some half a century after the birth of the neuromolecular gaze in the 1960s, we are seeing a concerted attempt, across Europe and North America at least, to argue that the discoveries in the neurosciences hold the key to the management of all manner of human activities and experiences, from psychiatric illness to economic behaviour, from human sociality to spirituality and ethics. It remains to be seen whether these attempts to translate from the molecular understanding of the nervous system to the molar management of human affairs represent a genuine advance in our understanding of the kinds of creatures we human beings are, or a premature and unwise extrapolation to society of the modest and always uncertain and correctable knowledge of the laboratory sciences. By ‘gaze’ is meant an ethos, an approach, a language, a perception, and a perspective brought about by the diverse techniques and practices involved in the production of this new field of knowledge. More comprehensively perhaps, by ‘neuromolecular gaze’ is meant a common vision of life itself. Although the neurosciences were characterized by their founders as an integrated multilevel approach to the brain and the nervous system, it is the molecular underpinning that prevailed marking both the success and challenges of these new sciences of the brain.

The Journal of Molecular Psychiatry often has interesting, seemingly relevant, but often complex articles that bear on my BPD and its current treatment regime. In 2014, for example, an article on antidepressants appeared. I quote from it briefly: "anti-depressants are widely used in clinical practice for the treatment of depression and other mood disorders." That is the case with me in the last 14 years since I went onto luvox or fluvoxamine in September of 2001. Luvox is used to treat both depression and OCD. The article continued: "Numerous neuroimaging studies have recently examined how antidepressants influence emotional processes. The neuropsychological mechanisms by which antidepressants act to improve depressive features remain underspecified." This under-specification was summarized as follow: "There were selective antidepressant effects on human brain activity underlying emotional processes. Antidepressants increased activity in the dorsolateral prefrontal, a key region mediating emotion regulation, during both negative and positive emotions in patients. Repeated antidepressant administration decreased brain responses to positive emotions in the nucleus accumbens, putamen, medial prefrontal and midbrain in healthy volunteers. Antidepressants act to normalize abnormal neural responses in depressed patients by increasing brain activity to positive stimuli and decreasing activity to negative stimuli in the emotional network." I have no idea just how this has affected my emotional life since 2001.

CREATURES IN THE GUT

The microbiome may yield a new class of psychobiotics for the treatment of anxiety, depression and other mood disorders. This was reported in a 2015 issue of the Scientific American. The ongoing exploration of the human microbiome promises to bring the link between the gut and the brain into clearer focus. Scientists are increasingly convinced that the vast assemblage of microfauna in our intestines may have a major impact on our state of mind. The gut-brain axis seems to be bidirectional—the brain acts on gastrointestinal and immune functions that help to shape the gut's microbial makeup, and gut microbes make neuroactive compounds, including neurotransmitters and metabolites that also act on the brain. These interactions could occur in various ways: microbial compounds communicate via the vagus nerve, which connects the brain and the digestive tract, and microbially derived metabolites interact with the immune system, which maintains its own communication with the brain. Sven Pettersson, a microbiologist at the Karolinska Institute in Stockholm, has recently shown that gut microbes help to control leakage through both the intestinal lining and the blood-brain barrier, which ordinarily protects the brain from potentially harmful agents. In May of 2015 I began to take acidopholus and I noticed a change in (i) my feces and (ii) my inner and outer relaxation.

ATTACHMENT THEORY

Part 1:

Research on human attachment has improved the practice of psychotherapy in part because attachment theory gives therapists permission to be “real” people with their clients. David Wallin’s book Attachment in Psychotherapy describes how to practice attachment-focused psychotherapy. He’s now working on a new book that looks at how a therapists’ own attachment patterns effect psychotherapy. Rather than acting like “blank screens,” and relying on emotionally detached, analytical interpretations to support clients’ attempts to heal childhood wounding, attachment-focused therapists instead facilitate healthy attachment-related experiences, which invariably means engaging in real and meaningful ways.

Of course, attachment theorists aren’t the only ones who see the relationship between therapist and client as central to the practice of psychotherapy. Psychodynamic psychotherapists have made the relationship the cornerstone of their approach, although many maintain an analytical stance towards clients. The Jungian analyst Robert Stein was an early dissenter to the emotionally detached, analytic approach to relationship. His book The Betrayal of the Soul in Psychotherapy explores the importance of making soul-felt connections with clients, which he argued requires a real, human connection. According to Stein, a soul-to-soul connection is the most healing aspect of psychotherapy (or analysis), which an analytical stance likely impedes.

The following quote is not from Stein, but rather from Jungian analyst John Ryan Haule who wrote the Foreward to Stein’s book. Haule describes the impact of the failure to witness soul. It’s a long quote, but I think an important one, especially as psychotherapy is increasingly discussed as both a failed paradigm of care and potential panacea for all that ails us. “Mainstream psychotherapy is complicit in our cultural blindness. Its rituals were established nearly a century ago according to Freud’s ideal of scientific detachment, the very same mentality that Western culture has been pursuing since the Renaissance. It pictures the encounter of therapist and patient on the model of two separate rational egos meeting to discuss dispassionately and to ‘analyze’ the unconscious forces that interfere with the patient’s attempt to live a rational life. The analyst is urged to be cool and emotionally uninvolved. In its most emphatic form, the ritual envisages an analyst who acts as a ‘blank screen’ for the projections of the patient. The patient is to learn as little as possible about the personality of the analyst. Rather the patient’s ‘projections’ recreate the neurotic structure of his life in the form of a ‘transference neurosis’ which can be dispassionately deconstructed.

Part 2:

“There is no place in such a scheme for the naked and disturbing encounter of soul with soul. In fact, therapy amounts to a ‘strange distortion of the human connection,’ where one party strives for objective distance while the other is urged ‘to become completely involved and entangled emotionally’. Psychotherapy as usual is an inhumanly structured encounter that blatantly repeats the injurious frustrations of the child whose parent refuses to engage with his soul. While the therapist is seen as a scientist/technician who coolly observes and measures, the patient becomes merely an object to be inspected, probed, and readjusted.

“In mainstream psychotherapy—as in our culture as a whole—the soulful human element is seen as a dangerous and destructive force that has to be held at bay. When Eros enters the space between therapist and patient, stirring up the terrible forces of soul meeting soul, we become convinced that something has gone wrong. We feel the overpowering draw to engage & the equally strong anxiety, shame, & confusion that Eros always generates. But we do not see it as an awe-inspiring mystery. It never dawns on us that this might be the 1st appearance of a healing and transformative energy. Rather we fall into a panic, terrified at the prospect of ‘sexually acting out’.”

Caginess often surrounds talk of love, soul, and psychotherapy. Where in our training do we learn how to deal with the first breaths of a long-dormant soul, let alone work with the formidable passion and energy that such deeply felt stirrings can release? Perhaps therapists should be a bit cagey, since therapy and sex should never mix. The impact can be so damaging as to lead to suicide.

Yet when therapists’ own wounds have led them to search the depths of their own souls, they often intuitively understand the path the client must take to fill a self that feels hollow, thus revitalizing the client’s self-love. This intuitive understanding may be the first meeting of the soul of the therapist with the soul of the client, even without therapists ever speaking a word of their own wounding. Such deep knowing can spark feelings of kinship and heartfelt compassion in the therapist, igniting a sense of commitment and containment that no doubt the client senses. This is part of the necessary crucible for healing. And if self-love is the goal of therapy, then it’s hard to imagine transformation and healing occurring without the therapist’s love and soul somehow in the mix.(References:(i) Stein, Robert. 1998/1973. The Betrayal of Soul in Psychotherapy. Spring Journal Books: Woodstock, CONN; and (ii) Wallin, David J. 2007. Attachment in Psychotherapy. New York: The Guilford Press.

LITHIUM

Lithium was and is, arguably, the central pivot in this whole story, at least to this point in my life at the age of 70.6 as I live through these middle years, 65 to 75, of late adulthood, a period some developmental psychologists characterize as the years from the age of 60 to 80. I was on lithium for twenty-seven years: from May 1980 to April 2007, about 40% of my total lifespan. I have experienced the symptoms of this disorder, this partially genetic disorder, after I received an official, a psychiatric diagnosis of MD, and then BPD, for 34 years: 1980 to 2014. In 1980, then, at the age of 35, I was finally given the diagnosis MD or BPD and, in May I began to take lithium. After 2 or 3 days the symptoms that required me to voluntarily go into the psychiatric clinic of the Launceston General Hospital, disappeared.

YEARS OF SUFFERING<

1. There were at least an additional 17 years(1963 to 1980) during which I was not diagnosed with BPD, but during which I had a range of symptoms and experiences I have described above and which were diagnosed(after 5 years of various symptoms) in 1968 as a mild schizo-affective disorder(SAD). I remember my first anti-psychotic drug Chlorpromazine (as chlorpromazine hydrochloride, abbreviated CPZ; marketed in the United States as Thorazine and elsewhere as Largactil or Megaphen). It is a dopamine antagonist of the typical antipsychotic class of medications possessing additional antiadrenergic, antiserotonergic, anticholinergic and antihistaminergic properties used to treat schizophrenia. First synthesized on December 11, 1950, chlorpromazine was the first drug developed with specific antipsychotic action, and would serve as the prototype for the phenothiazine class of drugs, which later grew to comprise several other agents. The introduction of chlorpromazine into clinical use has been described as the single greatest advance in psychiatric care, dramatically improving the prognosis of patients in psychiatric hospitals worldwide. This drug was prescribed to me in June 1968 in Verdun Psychiatric Hospital in Montreal.

1.1. Psychosis and so-called "mixed states", where depression and mania coexist simultaneously, do not defy explanation, but they are difficult to describe in words. Kay Jamison somehow finds the right words in her book The Unquiet Mind: "My body is uninhabitable," she recalls feeling, "raging and weeping and full of destruction and wild energy gone amok." This is one attempt to describe my experience of psychosis in late May and June of 1968. The largactil certainly hit this paranoia and rage on the head and during the period June to early December a psychiatric institution tried to stick me back together.

2. By December 1969, one year after leaving hospital, I had been treated and had re-entered society after those 6 months, in the last half of 1968, of institutionalized care. I got a job as a security guard on what was then Canada’s tallest building in Toronto in January 1969. And so, this has made 70% of my life, 52 out of 72 years during which I manifested some obvious features of a disorder of some kind: SAD, D, MD or BPD—not every month or every year but in various ways in these 52 years. I could also include some of my childhood and adolescent years but, since I have no memories of any emotional eccentricities or serious behavioural abnormalities during those years, except a very few details which I have already outlined in this account, I have not added any years before the age of 18.

3. My mood swings came to have an entirely different typicality in 2001, in 2007, and again in 2012. After eight months on the sodium valproate/fluvoxamine package of medication, my emotions, my feelings, were of quite a different order. Valproate has an antimanic efficacy; it lowers aggressive tendencies and impulsive-risk-taking behaviours; it may also be effective in treating my depressive symptoms concurrently.

THE DEATH-WISH

1. The death-wish which I had lived with periodically and in various degrees of intensity since at least 1963, diminished even more after 2007. This death-wish possesses now in 2014 only a faint trace of its past heat and power. It has not blown away entirely, but its intensity has significantly diminished. As I say, it is as a trace element, so to speak. My mood swings have moved into new territory several times since altering my medications in the last 13 years. The luvox in 2001 took my nighttime blackness away and the colouration of my emotions late at night became grey; luvox(fluvoxamine) was added to my medication package that year.

2. I make no attempt here to describe the phases and intensities of the death-wish in those many years of BPD. Before the official-clinical diagnosis of manic-depression in 1980, the death wish was not as dominant. I allude to it but do not describe the experience in even the most cursory fashion. In addition, I should emphasize here that the term 'episode' is a variable one and really needs a separate analysis, if this statement is to be as comprehensive as I would like.

3. Katherine Brooks, director/writer/filmmaker has written that: "I don’t believe Bipolar holds me back as a person or a filmmaker. I actually believe it makes everything I do have more meaning, passion, and purpose. I’m thankful to be this way, thankful to be born Bipolar." I can only go part-way with Brooks here. I am never thankful during the periods of intense depression, when the death wish has been playing itself out in my brain or, indeed, during the many periods when I seemed to be losing life's race.

LATE ADULTHOOD AND OLD AGE

1. There is very little high-quality evidence to guide prescribing for older people, particularly those with multiple medical conditions for which multiple medications may be indicated for those with various disabilities. Current best practice in prescribing drugs for late adulthood(60-80) and old age(80++), the geriatric patients of the world, relies on regular evaluation of the safety and efficacy of each medication and of the combination of medications for each patient. Functional and cognitive impairment are strong independent predictors and factors of importance. I am now, at the age of 71, in the "elderly" category.

INAPPROPRIATE TREATMENT and PROGRESS IN TREATMENT

1. Inappropriate treatment is a common concern and includes the use of medicines: (a) at too high a dose, (b) for too long a period, (c) or that induce harmful adverse effects when taken in combination with other medications through what are called drug–drug or drug–disease interactions. Another inappropriate way of prescribing occurs when a patient is denied the beneficial effect of a known drug on the grounds of advanced age. In such a complex medication milieu, and after decades of dealing with this disorder, I prefer to just leave the treatment regime to my doctor after brief consultations. The inappropriateness of a drug and the inappropriateness of a treatment, the inappropriate quality of a drug were not concerns I have taken on board in recent years. After I was stabilized on my most recent cocktail of seroquel(50 mg) and effexor(75 mg) more than three years ago in April 2012, I left the concerns to my psychiatrist. I should add here that my wife and I made judgments about the efficacy of my medication changes within the framework established by my previous psychiatrist eight years ago in 11 and 12/2007 during my last two consultations with him. This new psychiatrist has been treating me and my BPD now for more than 3 years.

2. Substantial progress has been made in the past several decades, while I have had to deal with the symptoms of BPD, toward the application of evidence-based medicine. Practice guidelines, which assist providers in clinical decision-making, have played a valuable role in this initiative. My former psychiatrist was a man in his late 60s with over 40 years of specialist interest in clients with BPD. The attributes of good practice guidelines, their role in the skill repertoire of my psychiatrist as a health-care provider and the limitations of practice guidelines for psychiatrists in general were concerns I did not have. By 2012, and now after two years with this latest psychiatrist, I have the utmost confidence in the treatment regime I am receiving. This is not to say that I do not consider possible changes in the years ahead.

3. I was also confident with my previous psychiatrist and the treatment he provided in the years 2001 to 2012. As a client it is important for me to know that my psychiatrist has some theoretical bases for his clinical interactions and that he is able to shift from one to another as appropriate. The philosophy and approach of my psychiatrist are things I could expatiate on at some length. He tries to figure-out how all my experience, and his knowledge, fit together in light of his clinical experience with clients who have BPD. It is important for me that my relationship to him be therapeutic, for my confidence in him to be there, for there to be some basic sense that “this guy knows what he is doing.” At the same time I want to see myself, in many important ways, as the expert in my own experience. The therapeutic relationship in itself is not constructed as a power struggle, like a game of 'tug of war', as it was back in the 1960s when I first had to deal with psychiatrists in an institutional setting.

4. And so the quality of the therapeutic alliance/foundation is very important; but so too is the theoretical orientation and the particular interventions my psychiatrist makes. After nearly 50 years of going to psychiatrists, I find that for me the best therapists are the ones who respectfully meet me wherever I am in the process of addressing the problems that brought me in, and the most important skill is attentive listening and reflection, along with the willingness and ability to ask hard questions in a kind way. Now in the evening of my life, in the middle years(65-75) of late adulthood, the years from 60 to 80 as some human development psychologists call these years in the lifespan—I am happy to receive the professional help of a psychiatrist and his expertise in medications. I do not seek out the several talk therapies found in the world of clinical psychologists and psychologists because I have not felt the need to do so, nor have I felt the need since my institutionalized care in 1968.

5. Perhaps some of the problems I had in the five years, 2007 to 2012, problems that resulted from what was then a new meds package, could be laid at the feet of what is sometimes called the ‘dinosaur syndrome’ of a psychiatrist. This is an experience BPD sufferers have who place themselves in the hands of an old psychiatrist well-rooted in his ways, using the same tactics that he was taught and has used for many years, indeed decades. My psychiatrist during the decade, 2001 to 2012, was a scholarly man and kept-up with his journals, but he was not on the internet and cyberspace has become a world of information even for specialists. By 2008, I had become comfortable with him and only went to see him about once every two or three years--when I felt the need to chat about my meds. I also became comfortable with the meds he had prescribed in that decade. In April 2012, though, I began to see a new psychiatrist largely through the influence of my wife, who was not that comfortable with his style. I am very glad, in retrospect, that I did change psychiatrists because the treatment regime, the new meds package, has been a very beneficial one. This process also illustrates what has been true since 1968, true in both my marriages, namely, the importance of my wife in my treatment packages. I may come to add a paragraph or two on this subject in a future edition of this now far too lengthy account.

A NEW PSYCHIATRIST

1. In 2010 I began to consider going to a new psychiatrist for a second opinion; I gradually obtained all the necessary information and the referral from my GP. But it took more than two years to decide to change from the old to the new psychiatrist and go on new meds. I will report on this new line of action below, a line of action that I began to actively take in April 2012, three years ago now as I write this update.

2. After chopping and changing psychiatrists, meds and life-narrative situations in marriage, family and employment from the 1960s to the 2010s, I became tired of the various manifestations of BPD over its several decades in my life and I was happy just to leave my sodium valproate(for BPD) and effexor(for OCPD and depression) package as they were even though this new package had significantly altered my behaviour and life-experience. My story had become a long one and I had no desire for endless chats about it, more detailed and written analysis or much internet participation. After a decade on the internet and joining many sites, I had come to limit my cyberspace participation in the mental health domain. My attitude with: my GP, my psychiatrist, my wife and with anyone who wanted to engage me in a discussion on the topic of my BPD---has become in summary: “let’s just refine the meds, if necessary & as desired, & I can go home.”

On 5 August 2010 my wife and I decided to refine the meds. I doubled the quantity of effexor from 37 & ½ mg to 75 mgs due to an outburst of anger and invective on 4/8/’10. In April 2012, I changed the meds pkg entirely. In the period between 4/8/'10 and 4/11/'12, 27 months, I got out of control twice. In the following year on the new meds I got out of control once. This lack of self-control in an extreme form has been a variable, a critical sign, that required action on my part in order to change my behaviour. Lack of control is still a problem now, even after three years on this new meds cocktail. The level of behavioural lack of control has, I would argue, not been very serious.

Oliver Sacks(1933- )a British neurologist, writer, and amateur chemist who is Professor of Neurology at New York University School of Medicine, in his recent essay “My Own Life" he tells us that he had received a diagnosis of metastatic melanoma and that his survival was likely to be measured in months. In this essay he described himself as of “vehement disposition, with violent enthusiasms, and extreme immoderation in all my passions.” I certainly had similar tendencies, but due to the fact that some of these tendencies were associated with my episodes of BPD, I have tried to counter them. I have tried to counter, to control, those behaviours of mine which have led to: anger, violent verbal and physical behaviour and whatever forms of excessiveness, of extreme, immoderate, unreasonable & whatever psychologically dangerous behaviours I exhibited.

EVIDENCE-BASED PRACTICE

Section 1:

1. There has been a lot of research on practice-based evidence vs. evidence-based practice. What's being learned is that real rapport between client/therapist determines 60% of the success of the therapy, 30% is based on the interventions the therapist uses and the remaining 10% is how much faith the therapist has in those interventions. Session Rating Scales have begun to be used. They are designed for clients to assess the key dimensions of the therapeutic relationship. Outcome Rating Scales have been designed to measure the area of life functioning known to change as a result of the therapeutic intervention selected. These instruments can be used by psychiatrists to obtain feedback from their clients but my psychiatrist has not used them yet.

2. Some critics of psychiatry argue that only a small percentage of psychotherapy services are tightly linked to existing scientific knowledge in the same way that, say, surgery and many other fields of medicine, are linked. This problem, say these critics, has multiple faces and implications. The fields of psychology and psychiatry have a hard time agreeing on what we even mean by mental disorders. There is a proliferation of theories and approaches. Different theorists have different axes to grind, so to speak. Managed-care companies have practice guidelines but often they just come down to ways to reduce cost. The American Psychiatric Association has practice guidelines, but medications are so emphasized that as a broad public information service, they are not very useful so continue these same critics. (For the following paragraphs I thank Steven C. Hayes, “Exploring Sensible Alternatives in Evidence-Based Psychotherapy,” The Huffington Post, 16 March 2011.)

3. There are at least two government efforts worth noting in the area of psychotherapy, and fortunately both are exploring acceptance and mindfulness-based alternatives in the area of evidence-based care that give consumers a wider range of choices. One worthwhile effort is by the Veteran's Administration(VA) to learn how to train, supervise, and monitor the impact of evidence-based practices when they are implemented in the VA system. It has been described as a beautiful and well-organized project. The VA has put millions into selecting a small number of evidence-based methods to deploy throughout their system, training hundreds of clinicians in these methods, measuring whether they have acquired and continue to use the actual skills (not just talk the talk), and then examining whether these methods lead to good outcomes for veterans.

4. One method that VA has developed known as Acceptance and Commitment Therapy (ACT), is one of the handful of methods the VA has decided to try to roll out into their systems of care. The results are not in yet. Unfortunately it takes a long time for the VA to share what they have learned. The VA is bureaucratic, to say the least. Within the next year or perhaps two we should learn what happens, positive or negative, when ACT (and other well-known evidence-based methods, such as prolonged exposure or cognitive therapy) are implemented systematically in a large system. It could be a very important series of reports. By 2014, though, I had opted for "a no-talk-therapy' treatment regime.

5. Right now in the U.S., the only publicly available and generally applicable governmental process for recognizing evidence-based mental health interventions is maintained by the U.S. Substance Abuse and Mental Health Services Administration. It is called the National Registry of Evidence-based Programs and Practices (NREPP). After a three-year review process, ACT was finally listed by NREPP an evidence-based practice. For the complete report on ACT, visit the NREPP website.). Here is how they describe ACT:

1. ACT is a contextually focused form of cognitive behavioural psychotherapy that uses mindfulness and behavioural activation to increase clients' psychological flexibility -- their ability to engage in values-based, positive behaviours while experiencing difficult thoughts, emotions, or sensations. ACT has been shown to increase effective action; reduce dysfunctional thoughts, feelings, and behaviours; and alleviate psychological distress for individuals with a broad range of mental health issues (including DSM-IV diagnoses, coping with chronic illness, and workplace stress). ACT establishes psychological flexibility by focusing on six core processes:

• Acceptance of private experiences (i.e., willingness to experience odd or uncomfortable thoughts, feelings, or physical sensations in the service of response flexibility)

• Cognitive diffusion or emotional separation/distancing (i.e., observing one's own uncomfortable thoughts without automatically taking them literally or attaching any particular value to them)

• Being present (i.e., being able to direct attention flexibly and voluntarily to present external and internal events rather than automatically focusing on the past or future)

• A perspective-taking sense of self (i.e., being in touch with a sense of ongoing awareness)

• Identification of values that are personally important

• Commitment to action for achieving the personal values identified

Section 1.1:

ACT is the evidence-based method, some argue, for people who don't like evidence-based methods. If traditional cognitive behavior therapy (CBT) methods have been tried and have failed, there is no reason to give up on science. ACT and the other acceptance and mindfulness-based forms of "contextual CBT" prove that evidence-based approaches can include a wide variety of methods. Consumers can care about science and still have a choice.

There are literally scores of ACT self-help books available from many different authors; there are thousands of ACT clinicians around the world and many more in sister approaches such a Mindfulness Based Cognitive Therapy or Dialectical Behavior Therapy. Modern acceptance and mindfulness-based methods are giving consumers a sensible, evidence-based alternative to dealing with their suffering, and that is a big step forward (for more information on resources available see the website of the scientific society developing ACT.)

2. NAMI, the National Alliance on Mental Illness, issued a report: “Grading the States in 2009: A Report on America's Health Care System for Adults with Mental Illness.” This is a very enlightening report and an informative website and it gives people with BPD a general picture of the quality of treatment programs in the USA, a picture like the one here in Australia where I have lived over half my life, half my experience with BPD.

DAILY SYMPTOMS THESE DAYS

1. The symptoms that have affected my daily working capacity for decades, and even now, are fatigue, psychological weariness and lack of emotional control in the area of anger. Anger, though, since going on my most recent medications, has been virtually eliminated. I still have to be sensitive to the arousal of anger since it has not been entirely eradicated from my experience. A night of light sleeping, tossing and turning or what some call 'agitation insomnia' tends to make me want to go back to bed during the day, and I often do, even now in 2015, for about 2 hours. This has been the case since April 2012 on my most recent medication regime.

2. After varying lengths of time in intellectual activity, 2 to 3 hours on average, I sometimes rest or go to bed in the last seven years. One can hardly complain, though, given that this fatigue, these experiences, psychological and/or physical weariness, are the lot of Everyman to some degree and in a myriad of different patterns. My story, my experience with sodium valproate, my lithium substitute, began seven years ago in April of 2007. Effexor was introduced into the medication package in May 2007 to replace the luvox. Sodium valproate is a mood stabilizer & effexor an anti-depressant medication, but more on these drugs is found later in section 4 below as well as on the internet for interested readers. Effexor(venlafaxine) is also used to treat OCD. My OCD behaviour seems to have increased since going off the lithium. This may be OCPD, obsessive-compulsive personality disorder, which I have discussed earlier in this account. This 110,000 word statement deals only tangentially with the OCD and OCPD behaviour in my life.

MOOD CHANGES AND TRANSITIONS

1. Since 1980, and more so since 1990, I have had little difficulty knowing where I was in the process of mood swing, psychological orientation and general understanding, although in the decade beginning in 2001 on the new medication packages I kept having to make adjustments in both the meds and in orienting myself to where I was at, so to speak. The chemistry and the relationship with brain functioning which is involved with BPD is very complex and I make no attempt to describe the chemistry, the anatomy and the physiology here in this document except in the most cursory fashion. Over the years I had grown used to the various plays on my emotions, my sleep patterns and my mental activity during the pre-medication phases and shifts as well as the post-medication periods of the medications prescribed.

2. During the mood transitions and the medication changes, the swing to a mild elation or euphoria was new, refreshing and quite pleasurable. The initial period of a few weeks when changing to NAVAL from lithium there was a period of instability and highly variable sleeping patterns and problems. During this transition there were a variety of symptoms, but I feel no need to outline them here.

3. The transition to the medication package in 2007 was very different than the one in 1980 or the second major shift in 2001—with the addition of luvox. The great intensities of swing had virtually gone by 1980, although the blacknesses late at night remained. After the introduction of luvox, though, as I said above, these blacknesses disappeared. Total acceptance of the necessity of taking lithium was a critical variable in this process and it took the decade of 1980 to 1990 to achieve. At the hypomanic end of the continuum over the years there were experiences like the following: violent emotional instability and oscillation; abrupt behavioural changes and a sudden change in a large number of intellectual assumptions; elation, high energy and various forms of excess. Mental balance, a psychological coherence between intellect and emotion and a rational reaction to the outside world all seemed to blow away, over a few hours to a few days, as I was plunged in a sea of what could be variously characterized as: emotional heat, intense awareness, sensitivity, sleeplessness, voluble talking, racing mental activity.

HYPOMANIC PERSONALITY

1. What I have described briefly above was my hypomanic personality at one end, the extreme end of the spectrum. At the other end of this same spectrum: fear, excessive paranoia, incoherence, intense depression or melancholia, despair and a desire to commit suicide were the major symptoms. This BPD spectrum includes a large number of mood disorders. The reason there now are so many different categories of BPD is partly due to this spectrum approach. With more reflection in the months and years ahead I may come to define my BPD experiences over the last seven decades along this spectrum more precisely. In the years from 1963 to 1965, in 1968, in the years from 1977 to 1980, when I went off lithium in 2001 and began a new series of medications from 2001 to 2012, I could utilize several labels from the psychiatric literature. BPD I, though, is the main label. For now I shall not go down this road of describing in more detail the sub-types of BPD at this point in this statement.

2. A hypomanic episode is defined as a distinct period of persistently elevated, expansive, or irritable mood, lasting at least 4 days, that is clearly different from the person’s non-depressed mood. In general, hypomania is not severe enough to cause notable problems in social activities, work or to necessitate hospitalization, and there are no psychotic features. Indeed, hypomania is a rich and delightful state in many ways: energy, confidence, joy. With another medication cocktail in 2010 I felt I had obtained the best of all possible worlds: some hypomania and a balance of energies. After 5 yearsw of what I then thought as "the best of all possible worlds," I slowly became disatisfied and, in April 2012, I went on yet another medication.

SUICIDAL IDEATION

Section 1:

In Part 1 of this book I mention suicide a dozen or so times. The term suicide ideation or suicidality is often used in contrast to actual attempts to commit suicide. I have not dealt with the subject of suicide in any detail in this once lengthy essay that is now a book. Since up to 15% of people with BPD die by suicide and as many as 50% attempt suicide at least once in their lives, I would like to emphasize before passing on in this account to other topics that suicide prevention involves: (a) decreasing the access to the means to commit suicide and (b) increasing access to support systems like doctors, therapists, family members and friends.

Evidence that selective serotonin reuptake inhibitor (SSRI) ‘antidepressant’ use may elicit suicidal thoughts and behaviours in people of all ages has been circulating since I began taking lithium in 1980. Luvox and effexor are SSRIs and I have not noticed any significant increase in suicidal ideation in the dozen years I have been taking them. I have lived with suicidal ideation, or what some call the death wish, in many different time-frames, for more than 50 years now(1963 to 2014) and the SSRIs have actually decreased the black thoughts to grey before going to sleep. This has taken the heat out of the death-wish. “There is a huge relationship between suicide and being under the age of 30, but that’s exactly the age group that is least likely to be compliant in taking medication,” Kay Redfield Jamison points out in her book The Unquiet Mind. My non-compliance continued into my late 40s. Like Kurt Cobain, the musician, I had problems with compliance but, by the age of 50 in 1994 that was no longer the case.

Section 1.1: Worldwide, one person dies every 40 seconds by suicide, a potentially preventable tragedy. A limiting step in our ability to intervene is the lack of objective, reliable predictors. Proof of principle for the use of blood gene expression biomarkers to predict future hospitalizations due to suicidality, in male bipolar disorder participants. We now generalize the discovery, prioritization, validation, and testing of such markers across major psychiatric disorders (bipolar disorder, major depressive disorder, schizoaffective disorder, and schizophrenia) in male participants, to understand commonalities and differences. We used a powerful within-participant discovery approach to identify genes that change in expression between no suicidal ideation and high suicidal ideation states (n = 37 participants out of a cohort of 217 psychiatric participants followed longitudinally). We then used a convergent functional genomics (CFG) approach with existing prior evidence in the field to prioritize the candidate biomarkers identified in the discovery step. Understanding and predicting suicidality using a combined genomic and clinical risk assessment approach. I leave it to readers to examine the vast literature on the subject of suicide.

ection 2:

Before leavning Jamison I would like to quote her once more in this brief review and comment on her book. “I believe that curiosity, wonder, and passion are defining qualities of imaginative minds and great teachers, and that restlessness and discontent are vital things." She continues: "intense experience and suffering instruct us in ways that less intense emotions can never do. It is important to value intellect and discipline, of course, but it is also important to recognize the power of irrationality, enthusiasm, and vast energy.” Jamison is a professor of psychiatry at the Johns Hopkins University School of Medicine and coauthor of the standard medical text on manic-depressive illness. It is a fascination with fascination that we read of her struggle against lithium, the drug that would ultimately save her life, and the drug that saved mine in 1979. She writes about her belief that she should handle her illness without "crutches" such as medication and about the severe side effects she experienced. Dr. Jamison also shares her deep resistance to relinquishing the exhilarating highs of the illness--"the intensity, glory, & absolute assuredness of my mind's flight"--for a life that seemed restrictive, less productive, and "maddeningly less intoxicating." Ultimately, she made peace with lithium only when it was clear that the alternatives were death or insanity. I made my peace in 1991; for me the alternatives were tears, a kind of emotional chaos and ultra-sensitivity. I did not want to cry when things got tough. They were not cathartic tears.

Section 3:

We know more than ever about suicide from its neurobiology to its epidemiology, treatment, and prevention. We know that mental illness is an antecedent to suicide in the vast majority of cases and that treating the mental illness is highly effective, whether it is a mood disorder, a psychotic disorder, anxiety disorder, or addiction. We also know that if someone has suffered an adverse life event or has an illness that is associated with depression, these are factors that can be focused on and potentially acted upon, to try to reduce the risk. We know that some telltale signs can emerge in individuals who are at risk during the period that may be imminent before a suicide. For example, making statements that life is not worth living; that others would be better off if the potentially suicidal person was not around; losing interest in things. There are a variety of telltale signs or indicators that suggest that someone may be thinking about suicide.

But individually, family, friends, and healthcare providers do not take action often enough, not as they would if this were heart disease and someone displayed manifold risk factors. As a society, we do not do enough to prevent suicide. We talk about it, especially when it affects one of our most beloved and well-known people, but again, we do not act on it. Suicide ranks as the 10th leading cause of death in the United States. Globally, an estimated 700,000 people take their own lives annually.[1] In certain populations, such as adolescents and young adults, suicide constitutes 1 of the top 3 causes of death. The literature on this subject is burgeoning and readers with the interest are encouraged to Google to their needs and interests.

MEMORY LOSS:

1. I was a classroom teacher and educator for over thirty years(1967 to 2003) and I have seen a good deal of short term memory loss in both myself and my fellow man and the myriad reasons we all give for forgetting, some justified and some not-so. The experience of memory loss in my own private domain, though, may be the result of: (a) the several medications I have had since 1968 and (b) the eight ECT treatments in the summer and autumn of 1968. But, again, everyone has memory problems; a recent test in 2005 administered by a doctor specialising in treating memory loss in geriatric patients, did not indicate any particular memory difficulty or the onset of any illness associated with memory loss, like altzeimer’s disease, a disease with its own trajectory of memory problems and functioning.

2. My previous psychiatrist, who specialised in treating people with BPD and who provided his professional advice to me until 2012, after a series of psychiatrists I have had going back to that period in 1968, does not think my memory problem is a central or even a peripheral part of my bipolar symptoms. If anything, my problem of memory has its origins in causes other than bipolarism. This was the same conclusion of that specialist in geriatric care, as well, whom I saw in 2005. After more than half a century of evidences of bipolarism in my life, I am inclined to think that my memory loss is, again, not something that should concern me unduly in this account of my bipolarism--even though it has been a practical concern in my daily life and I would like to say a few words about that problem in the following section.

3. My memory problem does contribute, as readers may appreciate, to many practical problems in day-to-day life. My wife is very aware of these problems which we have come to associate with: (a) selective memory, (b) inattention, (c) poor listening skills, inter alia. I mention these things because my bipolar disorder is largely treated. Whatever memory-loss I exhibit I do not regard as attributable to my BPD or the ECTs I had back in the 1960s. There is still a constellation of physical and psychological difficulties remaining, in addition to the residue of bipolar symptoms that are still present in my life. I do not want to emphasize these problems, this constellation of difficulties. These more peripheral problems detract from the central theme of this account. Their relevance is indirect, I must emphasize; they are not irrelevant to the way I experience my life.

4.1 Forgetfulness, distractibility and impaired executive function are manifestations of the normal ageing process in both humans and monkeys, and can be observed as early as in middle age, the years form 40 to 60, especially seriously in many cases. This decline in working memory is associated with pre-frontal cortex dysfunction, but the underlying molecular basis was unknown until now. Studies of the basic biology of ageing, the field of biogerontology, has seen a marked growth in scientific and popular interest over the past few years, leading to an influx of new investigators working on diverse aspects of cellular and organismal ageing. This diversity of topics includes: the molecular causes of ageing, cell senescence and apoptosis, stem cells, cancer, the genetics of longevity and anti-ageing interventions, among others. Although the range of topics is broad, there are potential models through which this diversity might coalesce into a more comprehensive understanding of how and why we age.

One theme underlying much of the discussion on these topics is which approaches—both current and future—might facilitate the transition from basic research to therapeutic treatments for age-associated diseases. The potential benefits of successfully accomplishing such a transition are considerable. For example, it has been estimated that a single intervention to slow ageing in humans—such as dietary restriction, which is now routine in mice—would increase life expectancy in the United States to a greater extent than simultaneously curing cancer, cardiovascular disease and diabetes (Miller, 2002; Olshansky et al, 1990). The molecular basis of ageing is therefore a timely and exciting topic. Again, I leave it to readers who have an interest in this topic to examine an aspect of my possible long-range journey in the lifepsan.

4.2 The good news in relation to the advances in life-expectancy and the advanced in modern medicine to prolong the lifespan, though, comes with significant challenges. Harvard-trained surgeon and medical writer Atul Gawande gives the following warning in his 4th book “Being Mortal: Medicine and What Matters in the End", a book which is a trenchant survey of the human costs of miraculous medicine and growing life spans. Even as health and longevity increase, he notes, society often fails in providing humane care for a dependent, increasingly feeble population. Trained to view death as an enemy to be conquered, physicians almost always are able to offer one more treatment. Patients and their families, struggling with the trauma of terminal illness, simply have no sense of when the battle should end.

“Death is the enemy,” writes Gawande, whose work appears in the New Yorker and scholarly medical publications, “but the enemy has superior forces. Eventually, it wins. And in a war that you cannot win, you don’t want a general who fights to the point of annihilation. We increasingly are the generals who march the soldiers onward, saying all the while, ‘You let me know when you want to stop.’ All-out treatment, we tell the incurably ill, is a train you can get off at any time — just say when. But for most patients and their families we are asking too much. They remain riven by doubt and fear and desperation; some are deluded by a fantasy of what medical science can achieve. They need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come.” Gawande’s book is sobering, at times difficult — if not painful — to read. I leave this to readers with the interest and, in some ways, the scenarios that Gawande provides could well apply to me in the late evening of my life as i head through these 70s, 80s, 90s and even years beyond 100 if I last that long.

5. Some research into BPD suggests that decreased working memory performance exists in BPD patients. This is reflected in specific neuro-functional deficits. These deficits may represent primary areas of neuro-pathology or be secondary to neuro-pathology elsewhere in the working memory network. Continued research utilizing other imaging modalites may further clarify the underlying neuro-pathology involved in these cognitive deficits. In general, though, my psychiatrists have informed me that the effects of BPID get worse with age. The future in the ageing process for many is fraught with the stories of people who have gradually waded into increasingly heroic, but futile, treatments that lead them to die, suffering in an intensive care unit tethered to tubes. Gawande calls such circumstances “a modern tragedy, replayed millions of times over.”

The impact of living with bipolar disorder over a lifetime is not clearly known. What is known is that proper management of the disorder is key to living a full and productive life. The prevailing approach combines medication and psycho-social treatment for optimal management over time. Because bipolar disorder is considered a recurrent illness in most cases, continuous treatment is recommended for proper symptom management. Working with your psychiatrist is critical to prevent extreme episodes of either depression or mania. In this regard, it is important that BPD sufferers inform their doctor of mood changes to help him or her determine whether a change in treatment is indicated. Keeping a chart of daily moods, treatments, sleep patterns, and life events may help the doctor track and treat the illness more effectively. This account is, for me, my main way of keeping track of my experience of BPID.

One thing is clear: The two strongest predictors of dementia are old age and family history, not bipolar disorder. Although there is much uncertainty about dementia's causes, the medical community recommends the following to minimize your risk: lowering cholesterol and blood pressure, controlling diabetes, getting regular exercise, eating a healthy diet, and engaging in activities that stimulate the brain. I do all of these things as I entered my 70s in 2014. Patients with bipolar disorder, it should be emphasized, are thought to be more likely to develop dementia than patients without the disorder.

6. Episodes of depression and mania may exact damage to learning and memory systems. An article by FC Murphy PhD and BJ Sahakian PhD of Cambridge University in the British Journal of Psychiatry draws a similar conclusion: "The balance of evidence supports a hypothesis of residual cognitive impairments in patients with BPD. It appears that our current bipolar medications actually repair and protect brain cells, which is one of the better arguments for staying compliant. Further research in this area may produce new drugs with enhanced neuroprotective properties.

7. Geriatric BPD is not uncommon; however, its phenomenology, course, and treatment are "grossly understudied." Kenneth Shulman, MD, from Sunnybrook & Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, discussed the challenges associated with treating BPD late in life. According to Dr. Shulman, "there is something special to learn about an 8 year old & an 80 year old developing BPD." The above and what is written below does not really apply to me since I developed BPD early in life and not later.

Still, it is worth noting that, although inconsistencies in prevalence rates exist, studies suggest that the prevalence of mania declines at the extremes of the life span. Elderly bipolar patients tend to be characterized by a late age at onset and a long latency from first depression to manic episode (average, 15 years). Moreover, many patients with a first episode of depression will experience several additional depressive episodes before the index manic episode. Mania late in life is also associated with a poor prognostic status and high morbidity rates. In a survival analysis conducted by Shulman and colleagues, morbidity rates for manic patients were significantly higher than for unipolar depressed patients; more than 50% of manic patients had died at 6-year follow-up. Other longitudinal studies report lower mortality rates. The high mortality rate may be due to natural causes in addition to suicide and illness "burnout." Additional outcome data suggest higher rates of treatment resistance and cognitive dysfunction associated with cerebrovascular disease in manic vs depressed elderly patients.

MORE GENERAL COMMENTS:

1. I have a file of detailed notes on doctors’ visits, various treatments for various problems and background information. It is a file I opened in 1999 on my retirement to assist me: (a) in treating myself for particular medical problems that arise and (b) to compensate for the memory problems I have mentioned above which I experience in relation to the several problems I have had that required visits to the doctor. Visits to GPs and my psychiatrist required several treatment regimens and I needed some system to record items I could not remember. But I have not commented on these notes nor included them here. The focus in this account of more than 100,000 words is on my bipolar problem and not any ancillary difficulties some of which are related to my BPD, like my potentially chronic renal failure, but most of which are not.

2. It seemed appropriate to outline this detailed statement of my experience with BPD for several purposes since the issue of the nature of my problem and what was once called MD, at least until the 1970s, is a complex one. The story varies from person to person and has been of concern to me over the 70 years that I have had to deal with its symptoms in my personal and professional life. Others close to me, some of whom are now called care-givers, have also had their concerns. It is difficult to characterize my condition and it is for this reason that I have written what some may find to be an overly long statement. As I say above, I write this for both my satisfaction and the use by others, especially those who suffer from BPD.

One of the many risks for sufferers with BPD is GPs(general practitioners) not realising how adults and adolescents with BPD may become suicidal from depression. This is common. This depression is associated with several factors: social isolation, the high levels of unemployment, the lack of close friends, the lack of a partner and the abuse that people with BPD may experience on the bus or in the supermarket or in other everyday situations. GPs need to give reassurance to adults with BPD. Just because their disability is invisible, they need to recognise that the patient is suffering underneath.

The suffering of those with BPD, their social facts and statistics, have galvanized me. Given the circumstances of my long-term self-identification with the status of nonviolent revolutionary, my cartography of its jurisdiction, and my life as an academic, my cultivated posture toward all forms of BPD including self-advocacy & activism for others, could indeed be summarized as fundamentally instructional and heuristic. I would rigorously resist the utilization of conventional constructions of apologetics, marketing, and propaganda in an educational setting. Most intellectuals share my distaste for confounding the artistry of teaching with any mode of salesmanship. To me, an intentional exercise of the latter within an educational environment might even approach academic dishonesty while suggesting a want of integrity. Although the merchandising of products has in its proper place, and there are many ethical sales representatives, that place is not in the lecture hall or classroom.

3. I hope this account, in both long and short term contexts, will explain adequately my reasons for not wanting to work in any employment position or participate in any demanding social context. It was for this reason that I drafted the first edition of this essay, this account, 14 years ago now in 2001. This account, now in its 15th edition, may provide those interested, as I also say above, with some useful information for dealing with their own particular problems, perhaps even problems not associated with bi-polarism.

4. I have a file, as I say above, of detailed notes on doctors’ visits, various treatments for specific problems and background information. It is a file I opened in 1999 on my retirement from FT work to assist me in treating myself for particular medical problems that arose and to compensate for the memory problems I experienced in relation to the several medical difficulties which arose from my mid-fifties onwards. Visits to GPs and my psychiatrist required several treatment regimens and I needed some system to record items I could not remember. But I have not commented on these problems and medical details here. The focus in this account is on my BPD and not any separate or ancillary difficulties.

THE PROCESS:

1. There seems to be a process, one of immense variability, that I have experienced on a daily basis for arguably, 70 years. The details, the symptoms, the behaviour, varies from year to year, with the decades, with the days and especially since my first D in October 1963 and since the medications I have been placed on since June of 1968. I cross from some normal behavioural constellation to an abnormal, intense one. The abnormal extreme position varies, as I say, from day to day, month to month and year to year in content, texture, tone and intensity. In 1946 it was characterized by uncontrollable early childhood behaviour and eccentricities. My mother had to deal with these aberrations.

2. Looking back to my childhood I did have some behavioural abnormalities, but their association with bipolarism is also, I tend of think, unlikely in retrospect. Behavioural abnormalities in children and adolescents are also as common as air and it seems to me, at this stage of the understanding of my disorder, that to impute bi-polarism may be premature at best and simply incorrect at worst. The diagnosis of bipolarism at that early stage of my life in 1947 at the age of three is only a remote possibility given that only 1% of people with BPD are considered to have exhibited BPD behaviour during their childhood or adolescence before their late teens. More knowledge of this disorder may yield a different conclusion at a future time especially since children and adolescents have been increasingly given the label, the diagnosis, BPD in order to explain their medical/behavioural problems.

3. The lack of reliable screening instruments in my childhood and adolescence that could have assessed my several mood, anxiety and behavioural conditions within the spectrum of a possible BPD was one of the problems in identifying conditions at these earliest possible points in time for effective intervention. If you are one of the many individuals who struggle with mood and anxiety symptoms as well as/or fear and anger--identifying your particular problem and beginning effective treatment can help you get back on track. For now, though, I leave this issue without further comment.

4. At the moment, at the age of 71, the negative aspects of my BPD are several, but I will go into these details, these more recent manifestations of this disorder, at least since 2001, in the next section of this essay or book. Due to the above "process" over more than sixty years, due to the part of the process which occurs in varying degrees in various accentuated forms, it has often been difficult to define just where I was at any one time along the 'normal-abnormal' continuum—and it still is. This was true at both the depressive end and the hypomanic end of the BPD spectrum.

5. It is difficult, therefore, to actually name the number of times when I have had major manic-depressive episodes. Perhaps the number is as many as eight. Certainly it is at least four in my whole life from what may have been the first episode in 1946 to the last brief episode in 1990 when I went off my lithium for between one and two months. Defining an episode is not easy for me to do; indeed, the concept of episode is only useful in some respects. In other ways it over-simplifies a complex set of behaviours; it has value, though, when trying to describe the experience in writing. The term episode serves as a sort of shorthand, a paradigmatic sign and symbol to cover a broad range of behaviour and over a wide set of time spans under one rubric. BPD has a complexity that has required, at least for me, medications, time, the wisdom of experience and, in some ways most importantly, a high quality carer to provide relevant feedback and understanding. These have all been keys, among others, to help me find the stability I so desperately craved from time to time.

6. Recent advances in computational neuroscience have led some psychiatrists to consider that the unusual perceptual experiences of BPD sufferers and their sometimes bizarre beliefs as part of the same core abnormality. This view results in seeing such experiences as a disturbance based on cognitive errors requiring an updating of inferences and beliefs about the world.

SOME THINGS I HAVE LEFT OUT:

1. The account above has none of the fine detail that I could include like: (a) details about my mental and auditory hallucinations during my psychotic episodes, (b) a long list of specific low-range fears and high range paranoias, (c) the electroconvulsive therapy, E.C.T.s I had back in 1968, (d) details of the developmental aspects of the various treatment regimens I have been given over the years, (e) the various psychiatric analyses and diagnoses, (f) the many years of dealing with suicidal thoughts and what some call a death wish, (g) experiences in and out of half a dozen hospitals, visits to unnumbered doctors’ clinics and listening to advice from well-meaning but usually misinformed or uninformed people than I care to recall, (h) adjusting to medications that varied from those which heavily sedated me and simply put me to sleep, to those which made me high, increased my sensitivities and sense of awareness of my environment—and still others that resulted in a state of paranoia, nausea and a sense of utter terror among other side-effects; (i) the effects of these many swings and mood changes on my employment, my relationships, my two marriages and my attitude to life; and (j) the problems in community life are difficult to untangle and describe here and would unduly lengthen this account.

2. The effects of BPD on my two marriages were many: too high a libido and in my case too extensive a demand for sex; a tendency to anger and additional strains and stresses. How much of this was due to my BPD is difficult to quantify. The effect on my employment was, again: anger, the temptations of the opposite sex and the desire for greater stimulation/satisfaction in my working life in general as well as a greater drive to succeed, to achieve. Motivation is a complex phenomenon and the relationship between work and its demands, BPD and my several manifestations of this disorder during the period from my birth to the age of 18.

3. Many of the situations, looking back, were humorous and the contexts absurd. And there was much else but, as I indicate, I hesitate to go into more detail. My aim here is to make a short(not short enough I hear some readers say!) clinical statement, to put some basic facts on paper, to outline some impressions, to make some analysis and draw some tentative conclusions. Perhaps later, in a further essay or posting on the internet--for this is the place my writing on BPD as a non-professional gets the most exposure--I will go into the kind of detail some readers have already requested. And so--I want to make this statement as short as possible, but as detailed as I can, to give a longitudinal perspective. At 75,000 words this account has become far from short, but it serves my purposes even if it is onerous for some readers to digest. I find, after several years of internet posting, that readers who find my account too long simply don’t read it. There is plenty of material on the World Wide Web for sufferers of BPD who require short posts, simple advice sketches and quick back-and-forth chat settings.

DIFFERENT BP PROFILES AND TYPICALITIES:

1. There are a variety of BPD profiles, what you could call different behavioural typicalities from person to person of those diagnosed as having BPD. It is bipolar because both ends of the spectrum, the moods, were and still are experienced over the period 1943 to 2015, 72 years. Thanks to lithium(1980), fluvoxamine(2001), sodium valproate(2007), venlafaxine(effexor-2007), and seroquel(2012)---most of the extremes are now being treated. There have been major shifts in mood (i) in the period of my life from 19 to 23 in 1963-7, (ii) at the age of 24 in 1968, (iii) at the age of 34 in 1978, (iv) at the age of 57 in 2001, (v) over the 60 month period 4/2007 to 4/2012 in these years of late adulthood and, finally--(vi) in the 3.3 years from April 2012 to August 2015 on a meds pkg of seroquel and effexor. It was my hope that this would be the final major shift in my life. In the twenty year period in the human lifespan from 70 to 90, if I lived that long, it was my hope that my present meds pkg would remain the same, but I think that unlikely. The diagnosis of pancreatic cancer changed all this and ended my story of BPD at that poin

Different medication regimes have resulted in an experiencing of life in very different ways. They brought me back to a centre, a normality, but I was somehow, somewhat mysteriously, inexplicably in some ways, never the same again after each shift. By 2010, at the age of 65, I had developed a marked asocial tendency which I refer to elsewhere in this document. Different medications affect different people in different ways, ways that this statement refers to briefly insofar as my life is concerned. This of course is true of all of us, each in our own ways, with our own stories of change, of crisis and of our own expressions of an often difficult to define normality and abnormality.

2. As I pointed out in a footnote to my introduction, the diagnosis that has been made in my case is a diagnosis that is standardized according The Diagnostic and Statistical Manual of Mental Disorders(DSMMD), 5th edition. There is a five axis system of diagnosis that is used in that manual and I refer readers to that manual and that five axis system for a more comprehensive view of just what I have left out of this statement. In my case: axis 1 is for clinical disorders in my case a mood disorder; axis 3 is for general medical concerns that relate to my BPD, axis-4 is for psycho-social and environmental problems that relate to my BPD and axis-5 is an overall caregiver’s assessment of my functioning on a scale 1 to 100.

3. It took ten years, from 1980 to 1990 as I say above, for me to fully accept the lithium treatment. From time to time in the 1980s I tried to live without the lithium, to go it alone, to go off it on a cold turkey, as they say colloquially. Such, in as brief a way as possible, is the summary of my experience over the years and, in the main, up to 1991. I have written more extensively of these years, and especially the issue of acceptance of one’s BPD and compliance with medication in my autobiography which is readily available on the internet for anyone who is interested.

4. Individuals with BPD have several characteristics that make them more vulnerable to substance abuse, addiction and compulsive behaviours. There is, therefore, a higher prevalence of people with BPD who have: (a) addictions, (b) OCD and (c) a higher vulnerability to substance abuse. As I have emphasized in this account, the experience of individuals with BPD, while having symptoms in common, is also highly diverse in its characterization. Over more than half a century now I have experienced, at various times: agitation & anxiety, aggressiveness and anger, belligerence and battle-fatigue, confusion and compulsiveness, impulsiveness and risk-taking, insomnia and irritability irregularity and morbid thought patterns, maliciousness and suicidal ideation, panic, paranoia & persecutory delusions, pressured speech and racing thoughts, restlessness and rage—not all at once, it must be emphasized, but at various times and, as I say, over many decades. One could find all of these behaviours in people without BPD but, for the most part, not in the same person. The concept of a profile of bipolar symptoms that could help clinicians diagnose BPD before an individual has a hypomanic attack as I had back in May-June 1968 is currently the object of the application of state of the art technology to genes across the whole genome.

5. As many as 60 per cent of people with BPD will have some form of substance abuse during their lifetime according to Ken Duckworth, MD, medical director of the National Alliance on Mental Illness(NAMI). When the BPD brain state can vacillate from foggy, unfocused and depressed all the way to hypomanic, hyperactive and manic, the internal environment of the person with BPD is not stable and is difficult to depend on. One powerful coping mechanism is to self-medicate with stimulants like caffeine, Adderall, Ritalin or even cocaine or meta-amphetamines. These stimulants push one’s brain and body into a state of high alert, often with side effects of mild to extreme anxiety, anger or fear but, at the same time, forcing one’s brain-state into the state he or she wants at the moment. The emotional complex here is often difficult to describe. This often leads to cycles of substance abuse and addiction.

IMPULSIVENESS AND SEX

1. The behaviour patterns of people with BPD are characterized often by: impulsiveness and sensation-seeking, risk-taking and thrill-seeking, novelty seeking and high exploratory drive, excitability and low levels of inhibition as well as the tendency to take more sexual partners and artistic activity. The term schizotypal personality is sometimes used for people with BPD who have a quirky or socially awkward approach to life. These patterns, it is argued by some neuroscientists, have neural correlates and are driven by individual differences in dopamine system sensitivity. The dopamine reward pathways of the brain are different in people with BPD.

2. Dopamine is a chemical that when released into the brain makes a person feel good. It acts as part of an internal reward system. Dopamine rewards are critical for survival since they provide the pleasurable feelings associated with things like eating and reproduction among other experiences in the lifespan. With dopamine as the driving force, biology has designed you and I to engage in fertilization behavior, sexual activity to make more babies, and urges you to move on to new partners to create greater genetic variety among your offspring. The thrill of a new affair is an example of the release of dopamine into the blood-stream. Keeping my control in place has not been easy. My religion, the Bahá'í Faith, has been more than a little helpful in this respect. The intensity of my sexual desires has been a strong one in my life, but I try not to let this activity take an undue amount of my time or my concern.

3. The French sociologist Jean Baudrillard wrote that “ours is a culture of premature ejaculation” which has many meanings outside the sexual domain like the lack of thought before speaking, before much of people’s activity in life. I could add more about this subject but, again, this aspect of my behaviour is essentially tangential to the central thrust of this BPD account. See: Jean Baudrillard, Forget Foucault, 1977.

4. As I say elsewhere in this statement, it is not my intention to dwell on my sexual life since, like my job, my family, my relationships and my religion, I regard them all as tangential to the focus on the BPD itself but I cannot eliminate reference to them on occasion since they are in varying degrees relevant to this narrative. Bahá'í teachings discourage pre-marital and extra-marital sex as well as masturbation and homosexuality. These same teachings go on to say that it is a lifelong test to learn to control one’s animal nature, one’s lower self and not be a slave to what are in many ways natural urges. Many of life’s tests and temptations, impulses and instincts require caution and vigilance, self-control and struggle so as not to let the sexual domain and their various activities claim too great a share of one’s attention. For many, certainly for me, the sexual domain has provided one of life’s major areas of personal struggle. This has been a battle for me nearly as far back as I can remember, indeed, even back to my middle childhood, the years from 6 to 8 years old!

5. When a person has BPD their brain does not reward them with a rush of dopamine easily, so they have to go to more extreme measures just to get that experience of well-being. That desperate desire for stimulation is also why many people with BPD self-destruct, engage in increased sexual activity and shopping among other excesses. Finding a creative pursuit that is truly engaging has been, for me, a great remedy for my addictive and OCD tendencies as well as my apparently above normal desire for stimulation. The pleasures associated with the passions: eating and drinking, sexual and sensory stimulation must all be kept within bounds and over my seven decades they have been, for the most part. Unexpressed creative impulses, so many argue, are the driving force behind some of the negative behaviours associated with BPD. On the other hand expressed creative impulses can be a positive driving force and, in my case, this has been especially true under the medication regime of the five years: 5/07 to 5/12 as well as this most recent regime from 4/12 to 3/13. It was also true at other highly successful points/stages in my teaching career: 1967 to 2005.

CREATIVITY

1. I would like to make two somewhat parenthetical remarks here in relation to creativity, remarks that I would not have made several years ago. Firstly, a phenomenon that has only emerged in society in the last decade, as far as I know, of people actively seeking out a diagnosis of a mental disorder and particularly bipolar due to its association with creativity. Perhaps they are looking for a justification for their own bad behaviour. The phenomena could also be due to increased public awareness through the internet, radio and TV, coupled with the willingness of celebrities to talk about their own personal experiences of mental illness.

2. Secondly, there is an aspect of mental disability that can be seen in some of the views of Martin Luther King's deeper philosophy of life. Instead of actively seeking a diagnosis of mental disorder, King sought to deny it. But he held the view that in our sick society we should be, as he put it, creatively maladjusted. As he said in a sermon on this topic: “Everybody passionately seeks to be well-adjusted, but there are some things in our world to which men of good will must be maladjusted. Human salvation lies in the hands of the creatively maladjusted.” Psychiatrists and psychologists call 'adjusted' those who are able to fit in, those who have the intention of fitting in, of wanting to be accepted and functioning well. The average teenager is obsessed with being adjusted, and so are adults, more than we care to admit: the average corporate employee, the typical professor, intellectual, television pundit. They are all rewarded for being well-adjusted. But this kind of normal thinking, this conformism, is deadly to creativity. The result of such an attitude is that a person would never have a new idea; the past becomes the future, and all problems requiring a person to think outside the box would become insoluble dilemmas.

3. Dr King realized that to solve the problems of human life, especially the deepest problems, like racism, poverty, and war, we have to become, in a sense, abnormal. We have to stop going along; we have to stop accepting what everyone else believes. We have to become maladjusted if we are to become at all creative. Insoluble dilemmas often are the masks for other previously unrecognized problems with simple solutions. Dr King knew what it meant to be maladjusted, psychologically, because he was not normal, psychiatrically. He had multiple periods of severe depression, and twice made suicide attempts as a child. Near the end of his life, some of his staff tried to get him to have psychiatric treatment, but he refused. There are aspects of these ideas of King’s that are relevant to my BPD story. There are questions and issues which are raised by what King is talking about here: what is normality? what are the problems relating to stigmatization? What does being sane in an insane world mean, inter alia.

1991 to 2015

1. The years 1991-2015 had several major turning points in my personal experience. The first in 1991 was the beginning of what for me was what is often called total drug-compliance. In my case the compliance was with lithium. I had had, to reiterate, in the first decade of lithium treatment, 1980 to 1990, a problem with compliance. The majority of BPD patients are non-compliant and tend to discontinue their medication after one year, and often with disastrous results. I had, therefore, lots of company in that first decade because I had discontinued my meds twice in that first decade: 1980 to 1990. BPD sufferers also lose years of productivity, normal health and life-expectancy. The first two factors certainly applied to me, although time will tell the extent to which that last factor will be true in my life.

2. Failing to educate oneself and/or one’s family inadvertently contributes to medication non-compliance and, in my case, this led to a serious relapse in 1990, but not to re-hospitalization. Knowledge is empowering and can improve one’s capacity to react constructively to periodic crises in one’s disability. This was the case in 1990. The relapse occurred in my summer holiday and by the time this holiday ended I was back on my meds and ready to go back to work due to the uncharacteristic emotional instability—the tears—that I experienced when I went ‘off-my-meds.’

3. From 1991 to 2001 I experienced a decade of euthymia, a term used for relative normality. This decade was much like an earlier decade of euthymia in my life, the years from 1969 to 1978. There is a tendency, and this was the case with me throughout most of the 1970s and again in the 1990s, to view my disorder as having acquired a somewhat benign course. I began to see myself as a “regular” person and my life as normal when I was really dealing with an existing, a quiescent, mental illness. It was very easy to slip into a manic-depressive state, a state with strong emotional-mood swings. These swings occurred in: 1963, 1968, 1978, 1979, 1980, 1991 and two or three times in the last 15 years, 2000 to 2015, necessitating in the process medication changes.

4. Effective prophylactic lithium medication controlled and attenuated my acute mood swings, minimized my sense of continuing distress and, I might add parenthetically, assisted mental health professionals' in simplifying the treatment of my disorder and in prescribing advice which I sought during the 27 years I was being treated on lithium(1980-2007). Psychiatrists were able to fit me into a category without my having to go through some long analysis. In that 27 year period that was all I wanted: “to get my pills and go home.” This may not have been the best attitude to take, but it represented the core of my attitude for most of this time. After seeing the wonderful effects of drug-therapy when I went on lithium in 1980, I was disinclined to engage in much talk-therapy, at least talk-therapy unrelated to the monitoring and adjusting to the several medication regimes I had been prescribed.

5. The malignant quality of BPD is insufficiently appreciated. It has been insufficiently appreciated by me—and still is--and by millions of other sufferers. The functional impairment found among BPD patients; the havoc and disruption reported to their occupational, family and social lives, suggests that, in spite of adequate drug treatment, disturbing problems persist impeding the optimal emotional growth and development of patients/clients as well as that of their immediate family members. Despite their significant effect on symptoms, lithium and drug therapies by themselves often have little impact on interpersonal problems and various psychosocial stressors that may develop in the course of the illness, an illness that often, although not always, plagues an individual over the person’s entire lifespan.

6. It is difficult to lock into, to describe, in this account this aspect of the interpersonal problems and psycho-social stressors I experienced. My account of the impact of BPD on the various facets of my life is really quite complex and I am still trying to work it out. By that I mean it is difficult my experience into words. Quite complex patterns of thought and behaviour over many decades do not lend themselves to easy description. In my efforts to do so readers may find that I jump from time frame to time frame in my lifespan. Readers may find that I compare and contrast different episodes while juxtaposing them within one particular period of time. Readers may find my account confusing because of these factors.

7. I may be able to sort out this problem of outlining a logical and clear delineation of my experience in some future edition of this story as I gradually come to refine this life-writing. But, for now, this current outline of my experience is the best I can do given the complexity of the disorder and how it has been experienced over more than six decades. I also want to be succinct and if I examine in any detail the effects on my work, family and relationships the result would be greater prolixity than has already resulted in this account.

7.1 In a world of alternative lifestyle options, strategic life planning becomes of special importance. Like lifestyle patterns, life-plans of one kind or another are something of an inevitable concomitant to living in our time. Life-plans are the substantial content of the reflexively organised trajectory of the self. Life-planning is a means of preparing a course of future actions mobilised in terms of the self's biography. The existence of personal calendars or life-plan calendars, in relation to which the personal time of the lifespan is handled is part of this process. As far as is possible I would like to build into this account some sense of a future orientation to my life as I deal with this ongoing BPD.

8. Visits to psychiatrists over that 27 year period each had their own framework of discussion, but I have not gone into the details of each visit. Most of the visits have hardly been mentioned in this statement because an outline of such details would increase the length of this analysis far too much. I have included the notes from the last two visits to my psychiatrist in appendix 1 at the end of this statement to provide some description and analysis of these visits.

MY BPD IN THE YEARS: 1991-2015

A. 1991-2001: “Luvox Arrives in 2001”


1. In the decade 1991 to 2001 I finished my life of full-time employment; I began to seriously reduce my extensive and intensive activities and responsibilities in the social and administrative aspects of the Baha’i community and its life, as well as other volunteer activities and social involvements. I also began my obsession with writing during this period. Rather than ponder the value of non-compliance with this medication as I had done in the 1980s, I came to a state of full-compliance; I came to appreciate, to fully accept, my lithium treatment. Anti-psychiatry has had many forms since psychology and psychiatry emerged in the last decades of the 19th century and the early twentieth and since pharmacology began to have more and more success in the last half century, say, in the years 1961 to 2011, my years of late adolescence to late adulthood. Like many of the mental illness/distress conservatives, they take a far too extreme position in relation to psychiatry from my point of view.

1.1 The handbook for mental health professionals lists different categories of mental disabilities and the criteria for diagnosing them. This handbook is published by the American Psychiatric Association. The DSM-IV, The Diagnostic and Statistical Manual of Mental Disorders(DSMMD), 4th edition, which was published in 1994, abandoned Freud for Kraepelin. Most psychiatrists these days use a model with combines behaviourism, cognitive psychology and pharmacological treatment. Some say that psychiatry has been at a pharmacological standstill for decades, although I think this is an extreme position. This manual, the DSMMD, is also the subject of much controversy, a controversy which this 50,000 word statement does not deal with here.(DSM-V-2013)

1.2 I would now like to focus on my more recent experience of the last 10 years, 1999 to 2009, the first years of an early retirement. My supervising psychiatrist in Tasmania suggested I go onto fluvoxamine maleate or luvox under its trade name, in addition to the lithium treatment. Luvox is an anti-depressant and it had been used in Australia at that time, in 2001, for about five years. Fluvoxamine(luvox) removed the blacknesses, what some have often called the black dog of depression that had dogged my life, mostly late at night, mostly since the late 1970s and which continued even after I went on lithium in 1980. Periodically, as I have already described above in the years 1963 to 1968 I also had these intense blacknesses/depressions. Back in those earlier years, though, these depressions lasted well into my daytime hours and traumatized my experience of work, leisure and family life in varying degrees.

1.3 Beginning in 1980 these blacknesses were only at night, from late in the evening—after midnight until early morning. For years I found myself entangled in a cycle in which I needed more stimulants in the morning just to wake up and get going, not because of all the "relaxers" as some people with BPD took the night before, but just as part of my mood-cycle. In the evening, while some others with BPD had extra stimulants still in their systems and who needed even more booze or drugs just to allow them to relax and sleep through the night, I was still super-charged. This super-charge slowly subsided as the evening progressed and, by midnight or 1 a.m. I was into the death-wish state.

1.4 The death-wish state has always been associated with the after midnight blacknesses, 1978-2001. It had been this way in the years before 1978 especially during that first episodic period 1963 to 1968 when my BPD condition was undiagnosed, when I had no idea what was happening to me and I was simply trying to get through life—sometimes not very successfully. With the administering of fluvoxamine in 2001, though, gradually the blacknesses, the nightly depressions, disappeared or virtually so. Black became grey as I have often said and grey is far superior to black in the mood department. Only residues, then, of a lower mood remained. The death wish remained as did sleeping problems, but in a much milder form. Like so many things in life, the death wish and mood swings have had varying degrees of intensity.

1.5 Coping is the key question with so much of this quite horrific personal experience of depression, for me and for others. Everyone has their key questions, their orientations and philosophies vis-à-vis: (a) the various approaches to pharmacology, (b) the many talk therapies and (c) the myriad alternative medicines and approaches to D, BPD and the various forms/labels given to the varieties of mental illness/distress in the public domain. The level of intensity of the discomfort which one experiences is a key determinant, among others, of how one understands and suffers whatever problem one has and its symptoms. The extent to which one copes varies from person to person and from year to year. This only states the obvious. Such is one of many ways of putting this quite complex idea. It is an idea, a process, not easily described, answered or understood and to expatiate on this aspect of the problem would quickly lead to a greater prolixity than the one in which I have already engaged here in this lengthy account.

1.6 Frequent urination and memory problems related, in part and perhaps, to the medications and shock treatments I had back in 1968, were new problems by the year 2001. But the dark and debilitating feelings which I had experienced for so many years late at night from midnight to dawn, were at last significantly lessened. After more than sixty years of BPD and/or manifestations of BPD in varying degrees of intensity, with periodic totally-debilitating episodes, most of the worst symptoms seemed at last, at least in the last eight years, to have been treated. They were not removed but they were successfully managed.

1.7 My anger episodes seriously diminished in frequency by the time I was in my early sixties, during the first years of fluvoxamine treatment in 2001 to 2004 at the age of 58 to 60 and especially in the year after I was stabilized on sodium valproate and effexor by February 2009. I changed my effexor levels in the period 2/09 to 8/10, as I mention from time to time in this account. I still had to watch, to monitor, myself because occasionally I still went over the edge and anger surfaced, inappropriate and uncontrolled anger. The manifestations of anger were on occasion a sign of my need to: (a) increase my effexor levels and/or (b) decrease my social interaction. In addition, in the early hours of the morning, say, from 4 to 7 a.m. life’s dark side would twist and turn like a worm and I had to make a fundamental distinction between the negative emotions and thoughts which arose due to my mental illness and those which arose from life itself. Most arose due to my BPD and the affects of the meds; the intertwining made it difficult to separate the two sources: illness and life.

1.7.1 Intermittent explosive disorder or impulse control disorder, triggered by irritability, seemed to move into a much lower register as I turned into the first years of late adulthood(60-65), and the middle years(65 to 75) of late adulthood(60 to 80). If I simply avoided situations that I knew would: (i) cause me to break-out, raise my voice beyond an appropriate register or behave in a violent way and (ii) result in behaviour that was an embarrassment to both me and others, I would be safe. By these middle years(65-75) of late adulthood, as some human development psychologists call the years from 60 to 80, I was much more aware of my limits and the dynamics involved, but I still got caught and had to reassess my interaction potential, ritual, capacity. Some psychologists place anger management as part of a simple subset of self-control issues. Self-control also includes: (a) skills like impulse control of all kinds, (b) the self-discipline to meet responsibilities, and (c) accepting delay of gratification when it's the best thing to do.

EMOTIONAL INTELLIGENCE:

1. All of this is what emotional intelligence is about or at least that is one psychological domain in which to discuss these and related issues. Daniel Goleman's best seller Emotional Intelligence: Why It Can Matter More Than IQ made the term Emotional Intelligence(EI) widely popularized in the late 1990s. EI describes the ability, capacity, skill or, in the case of the trait EI model, a self-perceived ability, to identify, assess, and manage one’s emotions, the emotions of others and of groups. Looking back over more than 60 years of periodic outbursts and varying intensities of inappropriate anger, say from 3 to 66, I can see an impulsivity and lack of emotional control as a key feature of my BPD. Self-management of my emotions is what I am after. I prefer this term to self-control. I don’t want my behaviour to get negatively triggered and hijacked by my emotions. The process, though, seems to be lifelong, a slowly learned set of skills and understandings and on this new medication package, 2007-2012, yet another set of feelings to manage which I discuss later in this lengthy account.

1.1 See Wikipedia for an excellent overview of the concept of emotional intelligence, the abilities involved, the wide array of competencies and skills that drive leadership performance, the understanding of oneself and others, the relating well to people, the ability to adapt to and cope with the immediate surroundings in order to be more successful in dealing with environmental demands and the weaknesses of the concept and its application.

1.2 The following are two of my many internet posts in relation to the many forms of mental illness—and in this case anger. This post will say something about my internet work in the field of mental health.

1.2.1 I first posted at Anger Management, a sub-section of "Psychology forum home" at the internet site entitled uncommon knowledge--nearly four years ago in July 2006. The thread that developed from that initial post had some use to both me and others. This post, this thread that I am initiating here in the autumn of 2010 here in Australia, is somewhat of an update, at least for me, of that initial post here at uncommon knowledge some four years ago.-Ron Price, Tasmania.

ELECTROPHYSIOLOGICAL RECORDINGS

Part 1:

Since I retired from FT, PT and volunteer/casual work in the years 1999 to 2005, I have been thinking about the anger component of my bi-polar disorder(BPD). In these last ten years, 2006 to 2015, the years of my full-retirement, I have come across various studies on the subject of anger which indicate that some 40 to 60 per cent of sufferers from BPD experience anger attacks. Sometimes the anger is seen in the context of a quite separate illness called "intermittent explosive disorder.” Sometimes, too, the anger of the sufferer from BPD is simply seen as related to, a part of, the BPD; sometimes the anger of the BPD sufferer is seen as just a normal part of his or her life. Most people experience anger in some way or another in their journey from cradle to grave. Indeed anger, in its controlled form, is quite a normal and appropriate emotion in life.

Part 1.1:

My intention here is to make some analytical comments on anger and its several typical expressions in my life. I want in this prose-poem to provide an overview of its appearance over the last 71 years of my life-narrative. “The man who gets angry at the right things,” wrote Aristotle, “and with the right people, and in the right way and at the right time and for the right length of time, is commended.”(1) I never really achieved this goal except: (a) indirectly through my writing, (b) partially in my daily life and (c) with the help of medications.

Part 2:

The first time I remember getting angry, in an uncontrolled ‘over-the-top’ sense, was just before my 20th birthday in the spring of 1964, just before finishing my first year of university. My mother’s sister’s son informed me when I was in my early sixties, though, that I had many a temper-tantrum in my early childhood. These tantrums seemed to die out by my middle childhood, the years 5 to 8, and I have no memory of these tantrums. The last time anger found a niche in my psyche was in 2015, some 16 years after retiring from full-time work. By then I was 70 and on an old-age pension. By my late fifties, I was able to mindfully dissolve my worst thoughts much more than I had ever been thanks to a new medication package. I was also able to successfully release the tiger of anger from its cage by buying a few precious seconds, recognizing the destructive potential of angry feelings as they emerged and bringing them down to manageable proportions but, still, only most of the time. But a new medication package which began in 2007 saw an increase in the frequency of anger and fear. By 2010 it began to subside again, and the new meds regime begun in April 2012 looks promising for my anger issues. After three years on this new meds package I still have to be on my guard insofar an anger issues are concerned.

Part 2.1:

It has now been more than 50 years from the ostensible onset of BPD in September 1963 to its latest treatment with several medication packages: fluvoxamine and sodium valproate, and now(2012 to 2015) seroquel & effexor. If I include those early childhood temper tantrums which may, in fact, have been manifestations of BPD(but impossible to assess now after the passing of 71 years) I could say I have had to deal with inappropriate anger for some seven decades. I now have a partial, indeed, a quite significant haven of peace. I can say with some pleasure and with a degree of contentment that I never had before: “peace at last, peace at last, thank god-almighty, it’s peace at last.” -Ron Price with thanks to (1) Aristotle, Nichomachean Ethics and My Autobiography: Pioneering Over Four Epochs, 31/3/'10 to 26/5/'15.

Such a long, long story—
life--punctuated as it is
by slices of a bad dream
on a stony-tortuous road,
never felt like a message
from the gods.....perhaps
that was what anger was!

A too-conscious memory
now leaving in its wake
unease, fears, anxieties,
hopes, resource for poets
and electrophysiological
recordings in confusion.(1)

Part of a cobweb, semblance
of reality in the theatre of life,
I am left now with feelings,
pictures and meaning looking
back in reflection over decades
with gathered associations by
that remarkable mechanism of
the brain and that gentle and
delightful tyrant, the memory
which dominates sometimes
softly and ethereally and also
sometimes not-so-gently filling
me, but only on the rarest of
occasions with a mild terror, perhaps,
until I exit from this mortal coil.(2)

(1) Electrophysiology is the study of the electrical properties of biological cells and tissues. It involves measurements of voltage change or electric current on a wide variety of scales from single ion channel proteins to whole organs like the heart. In neuroscience, it includes measurements of the electrical activity of neurones, and particularly action potential activity. Recordings of large-scale electric signals from the nervous system such as electroencephalography, may also be referred to as electrophysiological recordings.

(2) An excellent article on the subject of anger is entitled: Learning To Use Anger Constructively by Adam Blatner, M.D., an internet site by this name, 19 February, 2005. The article begins as follows: "Anger is a natural emotion and signals a need for a change in the environment. However, it is possible and usually desirable to express anger in modulated forms, and learning to do this is the hallmark of maturity.....It is useful to consider the range of situations that go with different levels of experiencing anger and discuss them fully with your partner--if you are one of those who are at least able to enter into such a dialogue. Many people, of course, are simply not able to discuss their inner life to any depth and so the sources of anger are never really dealt with.” Blatner then discusses 7 types of anger.

JEALOUSY

I also initiated another thread on a related issue of jealousy. Jealousy has not been one of the areas in life that has tested my psyche, although it did for several weeks in September just before I broke up from my first wife in late 1973. She had developed another relationship as had I with a member of the opposite sex. Hers was a relationship with a man whom she eventually married and to whom, nearly forty years later, she is still married. For those weeks in September, before we parted company and went our separate ways in early October 1973 anger and jealousy festered and they were a deadly combination. They have also been a deadly combination for millions of other couples. If not dealt with, they spell doom to most long-term relationships in our modern and post-modern age. My post at the internet site uncommon knowledge continued but this is the opening note.

IMPULSIVITY

Impulsivity can be thought of, described, in many ways. One negative way is to see it as a behaviour which seeks a small, short term gain at the expense of a large, long term loss. The essence of emotional self-regulation is the ability to delay the expression of impulses, to control one’s emotions in the service of personal goals. Impulse control disorders are also considered to be part of the obsessive-compulsive disorder(OCD) spectrum, a spectrum I can easily identify as part of my life as I gaze retrospectively at my years all the way back to early childhood. OCD is a mental disorder most commonly characterized by intrusive, recurrent thoughts and obsessions resulting in repetitive compulsive behaviours and mental acts that the person feels driven to perform to reduce a distress that is associated with these obsessions. OCD is a debilitating chronic psychiatric illness with a lifetime prevalence of 2–3% of the worldwide population.

OCD

Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder characterized by either obsessions (recurrent or persistent unwanted thoughts, images or impulses) or compulsions (repetitive behaviours or mental acts often performed to relieve anxiety or distress). The obsessions and compulsions of OCD cause significant distress to the afflicted individual. In my case the distress is minimal. Once believed to be rare, OCD is now estimated to affect between 2 and 3% of the general population and is the fourth most common psychiatric illness (after specific phobias, substance abuse and major depression). Patients with OCD have a poorer overall quality of life, and experience significant impairment in academic functioning, work performance and interpersonal relationships. In fact, OCD is estimated to be the 10th leading cause of disability in the world. The introduction of SSRIs and behavioural therapy techniques have improved clinical outcome in many patients. Due to what I regard as a low level OCD I have not sought treatment for my OCD.

In my case, my OCD is not excessively debilitating and, if chronic, it does not result in troublesome behavioural problems in my daily life. I see my OCD as a disorder that exists in a mild form as does my psychiatrist who goes so far as to say I do not even have OCD. OCD is a disease that has apparently exploded in prevalence in recent decades. I also suffer from Obsessive Compulsive Personality Disorder(OCPD) which I have discussed above in 1.11.1, 1.11.3 and 3.5.2 and which I discuss again in 9.2.4.1 and which needs to be seen in the context of OCD.

IED

The medical literature indicates that people who suffer from BPD experience ‘intermittent explosive disorder.’(IED) This lack of control, this uncontrolled form of anger, is said to be a biologically driven symptom of hypomania or mania, at least the relevant literature strongly suggests that this is so. My sexual urges, I might add, still remained, but they were less intense on the medication I began taking in April 2012 and even less after taking meds for my prostate problem. The interplay between two competing systems in the brain: the excitatory system and the inhibitory system which create, as one writer put it, an arousal template. As individual as a fingerprint, an arousal template is the total constellation of thoughts, images, behaviours, sounds, smells, sights fantasies and objects that arouse us sexually or arouse us in some other emotional way: visually, auditorily, inter alia. For me, these competing systems still competed into my sixties and had been competing virtually as long as I can remember. This framework of analysis based on an arousal template could be discussed in fine detail, but this is not the focus of my analysis of my BPD and its experience. It is, rather, a side issue, however pervasive an issue and however influential this issue has been in my life trajectory.

The word “explosive” was an appropriate one to associate with my anger episodes from the age of 18 until the age of 65 and with those temper tantrums I mentioned earlier in this account. But a mild anger, a more controlled anger, was a much more appropriate term than ‘explosive’ for this new emotional register after the age of 60. Once the new medication package of NAVAL and effexor was routinized and stabilized, by February 2009, any angry tendencies were ‘seriously controlled,’ although not entirely removed. If pushed, I could break out, so to speak. In the more than two years from February 2008 to January 2011, I broke out five times, getting angry at friends on four occasions, one very intensely making me decide to go back on my medication and kicking a dog twice, a dog which had bit my toes three times. I still had some work to do on that tiger in my tank!

SEXUAL PROCLIVITIES

My sexual proclivities and their manifestations over these same 60 years of memories are themselves a separate story. With 90% of marriages, where one partner is bi-polar, ending in divorce and a rate of suicide twenty times higher than in a normal population, I feel lucky to have survived and to have lived to tell my story. To be in the same marital relationship that I entered in 1975, thirty-five years ago, is also somewhat of a miracle. Perhaps I will go into the sexual, marital and suicidal/death-wish aspects of my BPD life in more detail at a later date, in a later edition of this document. These aspects of my account might spice-up this account, an account that for some I’m sure is a somewhat tedious story, a boring, a too extended description and analysis.

“Every passion borders on the chaotic,” wrote Walter Benjamin, “but the collector’s passion borders on the chaos of memories.” And this account is a collection, a chaos, of memories. It is a collection that is grounded in the interplay of material culture and memory studies and the recuperative veneration of the study of the everyday, the quotidian, as well as the study of my life in extremis . I could also recommend a number of books but I leave this to readers. Sarah Freeman provides an excellent minimal bibliography and I will mention one book here: Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, Second Edition by Frederick K. Goodwin, M.D., and Kay Redfield Jamison, Ph.D., Oxford University Press, NY, 2007, 1,288 pages.

CREATING MENTAL ILLNESS

I would also recommend Allan V. Horowitz's book "Creating Mental Illness" as excellent reading. He argues that the current conceptions of mental illness as a disease fit only a small number of serious psychological conditions. Most conditions currently regarded as mental illnesses are cultural constructions, normal reactions to stressful social circumstances, or simply forms of deviant behavior. He defined Mental Disease as conditions where symptoms include underlying internal dysfunctions. These are, he says, distinct from other disease conditions, and have certain universal features. Whatever conditions a particular social group defines as mental illness becomes M.I. This is, he argues, an actual labelling processes in any group and so cannot be true or false. In his analysis, he demonstrates how the medical models and social models of 'mental disorders' each have flaws to be addressed.

2002-2010: “SODIUM VALPROATE ARRIVES IN 2007”

1. In April 2007 I switched from the mood stabilizer lithium to sodium valproate. It became my main medication due to the fact that the creatinine levels in my blood, tested every 3 months for the previous six years and periodically and irregularly every year for 21 years before that, had been too high for too long—for about a year. These creatinine levels were indicators that readers of this document can read about in the BPD literature to see just how the kidney function can be affected by lithium treatment. I am not a doctor and I make no attempt to go into the finer aspects, the more detailed physiological aspects of this medical problem, this mental health illness. I have lived with it for years, but much of BPD as an illness is still beyond my level of analysis and the sophistication of my understanding—and it will remain so. My interest in the medical and scientific aspects of BPD, in spite of appearances to the contrary, are limited.

1.1 After all these years, my interest in fine-tuning my understanding, in enlarging my scientific knowledge of this disorder, is of a low order on my general scale of interests inspite, as I say, of any appearance to the contrary--as the evidence of writing this lengthy essay might indicate. Readers with a keen interest in the anatomical, the chemical and many physiological aspects of BPD can now read and study virtually any aspect of BPD on the internet if they have: (a) the computer skills and (b) the reading ability/level of competence.

BLOOD TESTS FOR MOOD DISORDERS

There are to date no objective clinical laboratory blood tests for mood disorders. The current reliance on patient self-reporting of symptom severity and on the clinicians' impression is a rate-limiting step in effective treatment and new drug development. Some recent studies involving genome-wide linkage analysis of mood and psychotic disorders have raised the possibility that there is a common gene for susceptibility to BPD and other psychiatric disorders and that is may lie in a specific chromosome region. This statement of mine does not examine developments in either genetic studies or other objective blood tests for the treatment of BPD. There are now many studies indicating novel insights into the genetic causalities of many major psychiatric disorders as well as into the aetiology of such disorders. To even summarize them here would lead to prolixity. One good example of studies in genetic causality is a study which may suggest that there are common and population-specific susceptibility genes for bipolar I disorder. (Molecular Psychiatry (2011) 16, pp. 548–556; published online 13 April 2010)

Blood biomarkers, blood tests, provide a scientifically useful and clinically usable signal in psychiatry, as they have been doing for other fields of medicine. In 2007, after being on lithium for 27 years my creatinine levels as indicated in blood tests were too high, and indicated my need to go off lithium or my kidneys would suffer even more. At the same time, it is important that doctors not jump to to premature conclusions, negative or positive. This can create confusion. Reproducibility is a hallmark of good science. Methodological clarity and rigor in terms of biomarker discovery, validation and testing is needed. A set of principles for what constitutes a good biomarker insofar as blood tests are concerned has now been developed for readers with the interest.

THE RELEVANT LITERATURE

Most of the people who ever read this document will not themselves be more than a little familiar with the relevant literature that relates to my problem, to BPD, although many may have a more than lingering interest in the disorder. Many readers here may have an interest in one or more of the many alternative medical treatments hypothesized by: (a) various health professionals and/or (b) the anti-psychiatry elements in society. Some specialized facilities, clinics and therapeutic centres under a variety of names, whose aims are to help BPD sufferers, combine a medical and an educational approach. Medicines and nutrients are often prescribed by physicians. To complement medical treatment, such programs often emphasize a wholesome diet, daily exercise and the development of habits that will assist recovery and support continued good health. Because of the strong learning orientation in such facilities, residents are often referred to as students rather than patients.

GETTING OFF THE HOOK

Jurriaan Plesman, a Nutritional Psychotherapist and author of Getting Off the Hook, offers his book free on the internet. For more articles see the free web site at: Hypoglycemic Health Association of Australia.

ORTHOMOLECULAR MEDICINE

The staff in such specialized clinics often includes professionals with credentials in psychology, psychotherapy, social work, substance abuse counselling and biochemistry as well as teachers of nutrition, exercise, arts, crafts, dance, drama, writing, and literature. Orthomolecular physicians are often at the core of these alternative medicine homes, clinics or residential care places and they supervise the medical treatment of the students. A visiting nurse, a behavioural optometrist, a chiropractor and an acupuncturist are often and also available.

MOLECULAR PSYCHIATRY

In the mid-1990s I first heard of the emerging field of molecular psychiatry(MP). This field has grown immensely in the past 20 years, and today, of course, the use of ‘molecular’ alongside ‘psychiatry’ is fully accepted. Yet the translation of the work of MP to improved clinical outcomes for patients with psychiatric disorders is still in the realm of promise. The major difference is that what was a faraway destination in, say, 1995, now seems to be tantalizing close, temptingly around the corner, almost within reach. There are pessimistic and optimistic ways to look at the field of MP now. Pessimistically, one could say that the gulf between knowledge and its application to improve people’s lives has never been greater. In the past 20 years, new knowledge gained in psychiatry and psychology has not resulted in conceptually novel treatments that have reached health-care delivery streams. Both the pharmacological and psychological treatments are conceptually old, bordering on the archaic. Optimistically, it could be stated that the amount of knowledge generated in the past 20 years has been truly amazing and that we are well poised to make major translational advances. If that is indeed the case, it would be appropriate to consider what the next 20 years might bring. I leave this to readers with the interest to follow-up on the developments in this interesting field.

Before leaving the topic of MP, I'll strike a note on pharmacogenomics which now being rebranded as ‘precision medicine’. This is a major area for progress in the field of MP. In his State of the Union Address on 20 January 2015, US President Barack Obama briefly announced the Precision Medicine Initiative—unveiled on 30 January 2015 as ‘a bold new research effort to revolutionize how we improve health and treat disease’. Launched with a $215 million investment in the president’s 2016 budget, the Precision Medicine Initiative will pioneer a model of patient-powered research that promises to accelerate biomedical discoveries and provide clinicians with new tools, knowledge, and therapies to help them determine which treatments will work best for which patients.

SOME ALTERNATIVES AND THERAPIES FOR BPD ARE:

1. (a) the Da Vinci Method outlined in a book by Garret Loporto. Those with BPD, so argues Loporto, need to learn how to evoke and manage the passion that elicits their hyperfocus, their energy and creativity. The BPD gene affects the brain's relationship with dopamine. This difference causes the person with BPD to: (i) crave stimulation just to feel alive and (ii) have unstable moods. Loporto does not offer a method nor does he offer a way to deal with the depression side of BPD. Readers of this book who suffer from BPD need to go elsewhere to help them deal with depression;

(b) cognitive behavioural therapy which helps people change inappropriate or negative thought patterns associated with the disease;

(c) psychoeducation which teaches patients about the illness and to recognize signs of recurrence;

(d) family therapy helps family members to help deal with the condition;

(e) interpersonal and social rhythm therapy which helps a patient with the condition deal with relationships and standardize routines and sleep behaviour in an effort to prevent manic episodes and avoid incapacitating depressive reactions;

(f) exposure therapy for complex anxiety disorders as well as BPD and

(g) vagus nerve stimulation(VNS) in which electric pulsing completely quashes the symptoms of depression. VNS was approved as a depression therapy for use in conjunction with drugs, by government regulators in the European Union and Canada in 2001. In June 2009 it became the first psychiatric device to be reviewed and approved in the United States which has more stringent requirements for medical devices. Other "wearable" devices are being tested and developed by other companies that involve transcutaneous stimulation and do not require surgery.

2. A little known, but potentially life-saving, fact is that common medications deplete vital nutrients essential to one’s health. For every dollar our society spends on prescription drugs, our society also spends a dollar to fix a complication. Understanding how nutritional supplements affect these drugs could make them safer and more effective. My wife and I, and especially my wife, give great attention to this reality and she tries to provide an excellent diet. The author I refer to here in this footnote provides a practical guide to avoid drug-induced nutrient depletion, and even replace your medications with natural supplements. I only want to refer to this topic here and, although I take natural supplements, I do not intend to replace my medications with them. Relative cost-benefit and efficacy studies comparing drug treatment to therapy are abundant. Pharmaceutical treatment is still the only option that provides quick and inexpensive care for problems like BPD with complex etiologies.

2.1 By the time I came to write the 12th edition of this ongoing story of BPD, I was taking fish oil, vitamin D, calcium, vitamin C, aspirin and zinc. Dealing with BPD has involved an ongoing concern for all sorts of aspects of life; having BPD sensitized me to many aspects of living I would not otherwise have paid the attention I have. On 26/5/'12, for example, I added magnesium to this package of nutritional and medical supplements. I added it for the following reason:

Magnesium is a mineral that helps maintain normal muscle and nerve function, keep heart rhythm steady, support a healthy immune system and keep bones strong. Some indications of deficiency of magnesium are: muscle tremors or spasm, muscle weakness, insomnia or nervousness, high blood pressure, irregular heartbeat, constipation, fits or convulsions, hyperactivity, depression, confusion and lack of appetite. Magnesium is interesting in bipolar disorder because of its chemical similarity to lithium (lithium being the drug most commonly used as a mood stabiliser). In fact, there is some evidence that the drug lithium may attach to the places inside the cell where magnesium is supposed to attach. In studies (Chouinard, Giannini), some people with bipolar disorder or other psychiatric illnesses had differences in the amounts of magnesium in their blood. There have been some studies where magnesium was added to other treatments to stop symptoms of mania or rapid cycling. Magnesium can block the entry of too much calcium into cells (it is a natural calcium channel blocker) which may explain why it is helpful with some symptoms of illnesses. Magnesium’s role in supporting good sleep may also be quite important here, since many people with bipolar disorder experience increasingly poor sleep patterns preceding a manic episode.

MY COMING OUT

One of the typical responses to my ‘coming out’ as a person with BPD in recent years is an urging that I seek out some alternative medicine milieu. In the past I have often entered into some ensuing dialogue with my friends, family and associations, my listeners and readers, students and laymen: in letter, over the phone, in conversation and now in email form or on the internet—a dialogue about the use of some other treatment than drug therapy. But this statement, this essay, does not explore these alternatives, the ones I have investigated and not investigated, nor does it examine the details of the biological and physiological, medical and anatomical aspects of BPD.

SEEKING ALTERNATIVES

After all these years I have lost any desire to try alternative/other treatment regimens/packages and now rely solely on: (i) my psychiatrist who is available for a consultation after a single phone-call and within the month, (ii) my medications which I am happy with and have no desire to change and (iii) my wife to whom I have been married for 40 years and who has the best understanding of me than anyone--to provide the core milieu for my current and prospective treatment regime. I take a general and somewhat detached interest in alternatives as they appear in the literature but, for the most part, I do not take them seriously as alternatives for my own path, for my own prescription for living. This is partly due to: (a) my lack of funds, (b) partly due to the fact that well-staffed alternative facilities with sophisticated treatment packages/process do not exist anywhere near where I live in Australia, but it is mainly due to (c) the fact that I am happy with my current treatment regime.

I leave the investigation of alternatives, of the finer aspects of the physiological and medical aspects of BPD and indeed the burgeoning literature on the subject to the keener students and readers here. I have been encouraged, found the courage, at least initially, in my coming-out due to several celebrities in the media who, since the 1990s, have made their BPD public. Stigmatization still exists, although it is not as strong as it was, say, nearly two decades ago in 1992 when I was stabilized on lithium and totally complaint, when I was working in professional employment, when I was active in local community life and, for the most part, kept my story under wraps, except on rare and exceptional occasions of ‘coming- out.’

MENTAL HEALTH THE THE MEDIA

1. If I were a Hollywood actor in the last twenty-five years (1985-2011), to say nothing of films in the last fifty(1960-2011), I would be calling my agent to be on the lookout for roles in which I could play a mentally troubled character. Dustin Hoffman in the 1988 film Rain Man won an Academy Award for Best Actor in a Leading Role for his portrayal of a man with autism; Kathy Bates earned her Oscar playing a madwoman in Misery in 1990; the next year, Anthony Hopkins earned one for the role of a cannibal, Hannibal Lecter; in 1993 Holly Hunter was the mute heroine of The Piano; 1994 produced Tom Hanks as the strange-mentally challenged but winning Forrest Gump; in 1995 there was the alcoholic Nicholas Cage of Leaving Las Vegas; Geoffrey Rush won the Best Actor award for his 1996 performance as schizoaffective pianist David Helfgott; 1997 was Jack Nicholson's turn for doing obsessive compulsive disorder; James Coburn picked up his Oscar as the sadistic paranoid father in 1998's Affliction; and in 1999, Michael Caine was a narcotics addict and Angelina Jolie co-starred as the sociopath of Girl, Interrupted. All of the following films featured BPD: Mr. Jones (1993), Pollock (2001), Sylvia (2003), Mad Love (1995), The Horse Whisperer (1998) and Michael Clayton(2007).

2. Overall, the mass media do a poor job of depicting mental illness, with misinformation frequently communicated, unfavourable stereotypes of people with mental illnesses predominating, and psychiatric terms used in inaccurate and offensive ways." The list of activities performed by people and various organizations dedicated to struggle against stigma is not only impressively long and wide-ranging, but provokes strong inspiration as well. I hope this extended personal account is seen by those who comes across it as part of that struggle against stigma.

3. Legislation and policy in mental health, disability, anti-discrimination and education now espouse principles of fair and equitable treatment for people experiencing mental health difficulties. In practice however, a major barrier to the enactment of these principles is non-disclosure of mental health difficulties by people who have these difficulties due to fears of discrimination. Stigma in its varying degrees of implementation and practice is still a major obstacle preventing people from disclosing mental health difficulties and receiving appropriate assistance. The future for people experiencing mental health difficulties in social work and welfare studies, though, is more hopeful than ever before. Further research, in particular, substantial comparative case studies, that include a brief mental health screening tool and demographic data, will result in the generation of transferable knowledge about the problems that people have who deal with BPD.

Perceived discrimination is an often overlooked but major source of health-related stress,with effects comparable to other major stressors such as the death of a loved one or the loss of a job. The risk for mental health and behavioral disorders varies according to the types and frequency of discriminatory experiences. When it comes to mental health, the results of recent studies suggest that the type and frequency of discrimination matters. It seems that it is the ongoing experience of multiple types of discrimination, including disrespect, condescension, hostile and character-based discrimination, all of which negatively impacts mental health. One such study was co-authored with Trenette Clark, the lead author, from the School of Social Work at the University of North Carolina, Chapel Hill. Michael G. Vaughn of the College for Public Health and Social Justice at Saint Louis University; and Keith E. Whitfield of the Center for Biobehavioral Health Disparities Research at Duke University were also involved in the writing of the study.

3.1 The year 1981 was proclaimed the International Year of Disabled Persons (IYDP) by the United Nations. It called for a plan of action with an emphasis on equalization of opportunities, rehabilitation and prevention of disabilities. The theme of IYDP was "full participation and equality", defined as the right of persons with disabilities to take part fully in the life and development of their societies, enjoy living conditions equal to those of other citizens, and have an equal share in improved conditions resulting from socio-economic development. By 2008 there were 3,900 athletes from 146 countries in Beijing at the paralympics. Although this extended discussion of the disabled portrayed in films and the disabled in sport is tangential to my BPD story, it is relevant to mention, en passant.

3.2 The illness I had suffered from, starting perhaps at my conception in 1943, had become, in some ways, a source of claim to fame. But it was not all a story of a new age of understanding. On television, that most popular story-teller in modern society, people negotiated their attitudes to and their understandings of different social and political issues of which mental illness/distress was but one. The most common disability portrayed on television during the years that this autobiography was being written, 1984-2014, has been mental illness/distress. We find the following mental problems portrayed: agoraphobia, BPD, autism, OCD, personality disorders, amnesia, various anxiety disorders and schizophrenia among others. People’s information and knowledge of the subject comes, for the most part, from TV which often perpetuates the stigma and the negative stereotypes by inaccurate depictions, misinformation and uninformed dramatic sketches. This has been part of the world of the mentally ill for centuries and it has been part of the backdrop of my own experience in these several epochs. In some ways it is difficult to appreciate how far society has come in its knowledge and understanding; in other ways the problems are massive and complex.

3.3 This autobiography suggests, exemplifies, a psychological reality that opposes and withstands the plague of popular fantasies that bombard consciousness in these epochs. My identity is not merely an image, ultimately empty, a symbol of another's demand on my life in an image-conscious society. I accept that image has become a central aspect of life today; indeed to some extent I revel in it. I play the game, but realize it's a game. I know that many of my desires I have been taught through my only partly avoidable immersion in society's realities. I have been hooked, as we all have been in varying extents, by the "aesthetics of consumerism.” "Coolness" and "glamorousness" I am aware of in some symbolic world that I inhabit in a depthless realm of masks, of images and brand names whose cache and status inevitably change, revealing no stable core at best or no substance at all.

3.4 But I know my reality is not image. The movies I have seen are entertaining but have only what some writers call a secondary reality. Consequently, I am plunged into and forged by a sea of signifiers which, while stimulating my sensory emporium, ultimately signify something approaching nothing at one end of the meaning and purpose spectrum to immense significance at the other end. I am conscious of body image but I get no sense, or should I say, little sense, of identity from my body. My psyche, to the extent that it is filled with electronic media products, is a void because that environment is an abyss, and the inner world, if one can call it that, which it recreates in this narration is just as depleted at least in some ways. This subject, which I have alluded to here only briefly, is a long and complex one and I shall leave it here.

3.5 The milieu of alternatives to mainstream pharmacology for my psychiatric disorder, my BPD, in 2011 is a different milieu-of- alternatives than was available in 1963 when I first had significant manifestations of this problem even though my BPD was not diagnosed as such until 1968; but this is a tangential topic or issue. As I indicated above, I no longer seriously consider alternative treatments since I am happy with my medication regime. But let me return to the new medication regime I began in 2007 and the kidney difficulty which led to these new medications.

3.6 Had I continued on lithium in 2001 I would have had serious health problems associated with kidney damage and I eventually would have had to go on a dialysis machine. As I write this 15th edition of my story, I have been on a seroquel-effexor cocktail for 3 years, and 4 months. I have now found a new routine, a new normality, for my sleeping pattern, although it has not been as difficult as the regime change in Iraq has been for the USA. This change in sleeping routine has been difficult to establish. The process of establishing a new sleeping pattern has affected me much more than the nightly stories do on the TV and radio about that distant and war-torn country or, I might add, the many other crises, disasters and many community concerns both within and without the Bahá'í community I have been associated with now for more than sixty years.

3.7 I always have a short sleep in the afternoon or early evening for one to two hours after I have been awake from my nightly sleep for from 1 to about five hours. Sometimes I go to sleep for an hour in the first 1 or 3 hours after waking, if I did not have a sound sleep the night before. After five years on a new cocktail of drugs(2007-2012), and yet another cocktail in the last 3 years (4/12-8/15), this new sleeping pattern has assumed a regularity, a new normality. BPD is associated with irregular or pathological functioning of circadian rhythms. The circadian rhythms are the regular rhythmic changes in waking and sleeping, waxing & waning activity levels, even sensations of hunger or thirst and their satisfaction. These rhythms become disordered when a person suffers from BPD. Sleeping and waking, as well as other patterns such as eating habits and activity levels, are disturbed. This internal clock is difficult to reset when a new cocktail of medication is administered.

4. After those five years(5/07-4/12) this clock had been reset. But it needed resetting, yest again, in the months after March 2012 since in April I went on a new meds pkg. Teenagers have problems with sleep patterns and there are now techniques available to help them regularize their patterns. I could use these same techniques for they are useful for sufferers of BPD. But I am happy now with my sleep patterns. For several months from August 2009 to January 2010 I took one panadol before going to bed to smooth out my sleep regime and it seems to have helped. But I discontinued the practice and the change seemed to have no effect on my sleeping experience. People tend to sleep more lightly and for shorter time spans as they get older. This is certainly the case with me, although I generally need about the same amount of total sleep as I needed in early adulthood—about 8 hours in every 24. I am currently sleeping an average of 8 to 9 hours every day and am in bed for an average of 11 to 12 hours.

4.1 Disrupted sleep is a common symptom of depression and BPD; one of the first things doctors look for in diagnosing depression and BPD are insomnia and excessive sleeping. Scientists have observed a dysfunctional body clock in the brains of people with depression. People with major depression, also known as clinical depression, show disrupted circadian rhythms across brain regions, according to a new study published in May 2013 in the journal Proceedings of the National Academy of Sciences. Researchers looked at post-mortem brain samples from mentally healthy donors and compared them with those of people who had major depression at the time of their death.

4.2 Until 2013 I occupied the same bed and occupied, too, the same space, the same house, day after day, as my wife. Routines and patterns have been and still are important. In 2013 we got separate beds but they are in the same room, side by side. I like to maintain a regular sleeping pattern and sleep with my wife as much as possible. My interest in this important aspect of my life is not for the sake of sexual activity as some readers might be keen to read about and as I would only be too keen to read about as well--and thus provide, in the process, a sexual-spice in this account and in my personal and sexual proclivities. In March 2013, as I say, we began to have separate but contiguous beds so that my wife is not troubled by my restlessness at night.

4.2.1 Chronotype is an attribute of human beings, reflecting at what time of the day their physical functions (hormone level, body temperature, cognitive faculties, eating and sleeping) are active, change or reach a certain level. This phenomenon is commonly reduced to sleeping habits only, referring to people as "larks" and "owls" which refer to, respectively, morning people (those who wake up early and are most alert in the first part of the day) and evening people (those who are most alert in the late evening hours and prefer to go to bed late).

Humans are normally diurnal creatures, that is to say they are active in the daytime. As with most other diurnal animals, human activity-rest patterns are endogenously controlled by biological clocks with a circadian period. Normal variation in chronotypes encompasses sleep and wake cycles that are from about two hours earlier to about two hours later than average. Extremes outside of this range can cause a person difficulty in participating in normal work, school, and social activities. If a person's "lark" or (more commonly) "owl" tendencies are strong and intractable to the point of disallowing normal participation in society, the person is considered to have a circadian rhythm sleep disorder. In the last 15 years I have not been in paid employment and can go to bed late and get up late since I have always been an owl and not a lark.

4.3 I’m sure by now some readers are finding the absence of some of the frequent absurdity of BPD behaviour, frequent stories of sexual and other behavioural abnormalities and/or any general eccentricities in my day to day life, which often characterizes BPD stories, is making this narrative far too clinical, indeed, overwhelmingly clinical and analytical for their liking. I go into the sexual aspects of my disorder to a greater extent in my memoirs or autobiography. I do have my eccentricities, as some of my friends and associations would/could easily point out. Perhaps I have more strange traits than most. But as one famous aphorism states: “everyone is a bit strange, except me and thee—and even thee is strange.” This aphorism underlines one approach to this complex issue of human eccentricity and its various manifestations in community life.

4.4 Antidepressants have many side effects, one of which was decreased libido and this was true of the two antidepressants I took after 2001, luvox and effexor. But this was only marginally true. Finding the right combination of BPD medications to control a hypomania that tends toward mania has been a helpful step toward keeping my hypersexuality, if I can call it that, from becoming destructive. With the accelerated availability, publication and distribution of pornography in more accessible, anonymous and affordable forms on the internet and in the print and electronic media, it has become much easier for me to tap into my arousal template, easier than, say, it had been in the years since Playboy came on the market in 1953.

4.5 I should mention here the side effects of the effexor since it had become, with NAVAL, a key component of my meds by 2007. Diarrhoea, dizziness, heartburn, gas, unusual tiredness or weakness, abnormal dreams and anxiety, muscle tension, yawning---and, I should add, frequent urination due to 27 years(too long) on lithium. As I write these words in August 2015, I have now had some 8 years of these "abnormal dreams." I have written about them in Part 1 of this 350 page narrative-analysis, and so I will not discuss them again here other than to reiterate that they give me a feeling of immense fatigue when I wake up.

4.5.1 The stimulation of my libido, my id, my libidinal urges continued, but virtually ceased, as I mentioned above several times. One can only avoid stimulation if one keeps entirely away from the print and electronic media. There are new difficulties in our society, in developed societies, resulting from the demands of a sexual morality utterly at variance with the massive sexual propaganda and its enhanced and erotic stimulation to which all consumer societies are subject. It is not my purpose to focus on this aspect of my life’s behavioural trajectory here, but I would like to make a general comment in the next section 5.12, on the line between negative behaviours that genuinely derive from my BPD and those behaviours that are simply convenient to blame on BPD.

5. When faced with negative behaviours in the sexual, verbally aggressive, verbally immoderate domains or, indeed, any form of excessive behaviour, the question as to where one draws the line between: (a) what to blame on BPD or one of my other disorders and (b) what to blame on simple lack of self-control is a difficult and ongoing problem. Is there any way to clearly differentiate between these two possible explanations of my negative behaviours in these areas? Can I accept as valid an airy, dismissive "oh, I can't help myself, I'm bipolar" and yield to my instincts, drives and emotions?

6. Psychological problems and disorders like BPD, OCD, OCPD and PTSD as they are defined in the DSM-IV, constitute the only nosology, that is the only medical categorization system, without clear aetiologies, that is without clear neurological causation. Research in neuroscience is gradually moving toward the point where some of the aetiology/causation as well as the lines of differentiation, are becoming more apparent. However, for the time being, there does not seem to be any way to state definitively one way or the other.

Traumatic fear memories are highly durable but also dynamic. They undergo repeated reactivation and rehearsal over time. Although overly persistent fear memories underlie anxiety disorders, such as post traumatic stress disorder(PTSD), the key neural & molecular mechanisms underlying fear memory durability remain unclear. Post-synaptic density 95 (PSD-95) is a synaptic protein regulating glutamate receptor anchoring, synaptic stability and certain types of memory. Readers with the interest should go to any one of several online journals like Molecular Psychiatry if they want to study this subject in more detail.

6.1 I thank Mark Foster for his post on this theme at bahá’í-mental-health @yahoogroups.com, 12 July 2008. In addition, I want to emphasize here that developments in the basic neurosciences will hopefully be translated in the years immediately ahead into more efficacious diagnostic, preventive, and therapeutic interventions. There is an urgent need to transform basic research discoveries into tools for the treatment and prevention of mental health difficulties. Efforts to stimulate the translation of basic and clinical neuroscience findings into novel targets, models, compounds and strategies for the development of innovative therapeutics for psychiatric disorders are bringing results but often more slowly than surely. I could highlight here some examples of collaborations and partnerships among medical research, academia, and industry, but that is beyond the focus of this account.

6.2 I should add here, somewhat parenthetically but still importantly, that there are many who might be, and often are, called mental illness/distress conservatives. Such "conservatives” don't believe in mental illness/distress. Rather, they believe patients make a conscious choice to be mentally ill, just the same as others choose to be gay, and some choose to be drug addicts, among other addictions and disorders. The term mental health service users is often preferred to the term patients. While I think there is some truth in this remark, I would not want to push this view too far and apply its results in terms of a treatment that would result in all circumstances. This position is an extreme one from my perspective, too extreme for my liking and in my experience. It is a position, though, that would/could sometimes help BPD sufferers. It is one I held myself for a decade(1969-1979-circa) when I refused to take medication and tried alternatives which I have discussed elsewhere in this statement. There are also the anti-psychiatry people and they are in a similar basket to the conservatives.

7. This conservative position, this form of advice, though, could be more than unwise. It could be criminal. In my case I have come to see my treatment regime in terms of getting the right medication balance and now that I am 67 and on two old age pensions I hope I have at last found this balance. Time, of course, will tell. Even if I assume I have the right balance in medication, there is still the problem of behaviour and this problem in its many forms is far from solved.

7.1 I could expatiate on this theme since my espousal of this conservative position was, in the end, not a wise one. There were times when my behaviour was sufficiently ‘normal’ as not to require meds, but there were times when there was no substitute and, indeed, until modern pharmacology, there was no substitute no substitute for the extreme aberrations of behaviour of BPD sufferers. Many self-medicate with alcohol for the depressive side of BPD or cocaine to obtain the stimulating side of BPD--among other drugs. This was never one of my ways of dealing with mood swings.

7.2 In all this discussion, however, it is important for me that, however much science can quantify neurotransmitters, nerve pathways, cellular processes, complex amino acid structures and brain chemistry, it cannot weigh or dissect a mind. Some modern writers use the word ‘mind’ because they don't want to use the word soul or they consider the mind as a property of the soul. Many scientists loosely use the word ‘nature,’ that is the mechanisms of the physical universe, where others might be inclined to say ‘creation’ of which nature is just the evanescent part. These philosophico-psychologico-religious issues I do not deal with in this document. However interesting these issues may be to some readers, they are tangential to the central focus I try to maintain throughout this statement—and I therefore do not deal with them in any detail.

7.3 Routines are important when living with others, as I mentioned above, in different ways than when living alone. Much must be done for the sake of a more harmonious and general interaction due to the interdependence and interrelationship that exists. In May-June 2007 when first going on this new medication package my sleeping patterns varied from 2 to 4 hours per night. They gradually became a regular eight to nine hours with a waking and getting up two or three times for urination. Included in those 8 hours is a sleep for 1 to 2 hours in the day/evening: (a) to make up for the loss of sleep at night, (b) to give into a tired feeling or (c) due to my new circadian rhythm.

7.4 My wife has helped me in this area of sleep-monitoring, although she came to find it frustrating, the endless discussion of sleep and its patterns. I should add, somewhat parenthetically but very importantly, that since the late 1970s when the first episodes of this disorder appeared during this my second marriage, my second wife has been my main care-giver. I have been her main caregiver, but that is a separate story which I briefly refer to below. We have each been for each other the main care-givers over these many years. We have not, though, applied for care-giver status and its remunerative package from Centrelink a sector of the Human Services Department here in Australia for reasons explained above.

7.5 My preference and need for sleep seems to be from 8 to 9 hours on average per day. This is slightly more than has been the case since the early onset of this disorder back in the 1960s, although in my teens and twenties, as in my childhood before, sleeping patterns have had great variations. The whole question and story of sleeping patterns is a long and complex one and I don’t want to go into any more detail on this theme than I already have; indeed, concern for and obsession with sleep is a characteristic worry of many of those who suffer from BPD and over the years I have often written pages of analysis and gathered pages of data on my sleeping patterns, but I will limit my discussion of this subject in my life at this juncture in this essay.

7.5.1 My relationship with my wife has not always been a smooth one and neither was my first marriage. In both marriages, though, my wife has been a great help to me. In the case of my first wife she visited me in the hospital daily from her home in Toronto to the hospital in Whitby during my first major BPD episode that last several months. My second wife has lived with my inevitable ups and downs for 40 years (1974 to 2015). I have had ups-and-downs both inside and outside of marriage and I have alluded to them in my memoirs. I do not go into detail on these personal ups-and-downs in this account. There are a host of behaviours and activities in my life that were affected by my BPD but, in the main, my focus in this account is on the BPD itself and my efforts to treat it, to deal with it and not the myriad manifestations of problems and behaviours that resulted decade after decade, year after year.

7.5.2 One such area I could expand on, for example, is found in a behaviour or tendency toward a type of borderline personality disorder(BoPD). This behaviour is typified by: (a) a marked unsteadiness or instability, and (b) a reactivity of mood, sometimes called emotional dysregulation. This emotional dysregulation is the response to external psychosocial and intrapsychic stressors. This sense of unsteadiness, instability or emotional irregularity may arise or subside suddenly and dramatically within a few minutes and last for seconds, minutes, hours or days. In my case the psychosocial stressor has often been some criticism of my behaviour. The phenomenon is complex and difficult to deal with here in a few words, but the intensity of negative feeling that is aroused is out of all proportion to the critical remark made.

8. Flux is part of the fundamental nature of BPD. The terms raging and swinging as well as mixed and emotionally-episodic are, for me, words that characterize and describe my experience of BPD over the years—not 24/7, as they say, but certainly periodically. There are several typologies of BPD from two to five. I do not want to go into the detail that describes the types, but an awareness of these sub-types can help individuals with BPD who want to understand its several manifestations. Individuals with BPD often have periods with many changes in energy, mood, thought, sleep and activity.

APRIL 2007 TO APRIL 2012:ENTER VENLAFAXINE

1. I have a solid base of experience now with venlafaxine or effexor as it is known commercially. After five years on this new medication(4/07-4/12), combined as it is with sodium valproate, the future on this medication package looks promising. A new sense of normality, of my old self, in an ironic sort of way, had already returned in the first two months(4/07-6/07) of my being on the final element of this new medication-cocktail, venlafaxine. The symptoms of my OCD have significantly dissipated, although they are still present in an abnormal way from my wife’s point of view. This notion, though, of “my old self” only lasts for two hours of so and I begin to tire quickly and often need to go to bed and either rest or sleep.

2. My wife is the person who observes me more than anyone and her opinion is important in making this statement and in forming the view of myself that I hold at any one time. This might be called ‘the social construction of reality’ as some sociologists call this way we come to view ourselves.

2.1 I can feel what I often describe as ‘the healing effects’ of this medication package. My wife calls this healing effect a sense of well-being and she sees it as characterized essentially by less frenetic activity. It looks like I am going to win the battle with BPD, although I had my doubts even as recently as April 2007. I must accept, though, the decline in my social functioning and my need for 2 hours of sleep during the day.

2.2 In the past the battle has periodically looked like a situation of utter defeat, a sense of defeat I first experienced as far back as those October evenings in 1962 when I first suffered a blackness I had never felt before. I had, at that time, no idea what was happening to me. Frenetic activity is still present and my wife could give a running commentary on this aspect of my behaviour even now after four years on this new medication package. When I say I am winning the battle with BPD, readers should not read into this statement that (i) I never get despondent or (ii) don’t experience very negative feelings. These feelings enter my being, as I’ve said on occasion in thi lengthy account only before going to bed.

2.3 The effects of BPD on my day to day life seem to have been finally put into a reasonably comfortable niche so that I can go on with the next chapter of my life. The negative effects may rear their ugly heads, yet again at some future time but, for now, I can put this account to bed. I have to thank my psychiatrist for his skills and expertise and the medications and consultations that are part of modern psychopharmacology and psychiatry for this progress—in the main. The profound advances in bio-medical knowledge and research so rapidly accruing today, although not being effectively transformed into meaningful advances in health care for literally billions of people in our global society, are being brought to my attention and applied to my BPD, as they are to other billions on this earth. The worse that can be said about the skills of my penultimate psychiatrist is that at more than 70 years of age he offers to me a more traditional pharmacological approach and he is not likely to experiment with: (a) other medications for BPD or (b) alternative treatments as younger/other psychiatrists might do.

2.4 When I say that I can put this account to bed I do not mean to imply that my personal response patterns in day-to-day life do not involve imbalances, immaturities and imperfections, as I have indicated above. I am often unaware of these patterns even after these many years of living and dealing with BPD. My wife helps to keep me conscious of my behavioural failings in these areas. I am often simply unaware of both my external behaviours and the internal messages, the triggers, what might be called the inner psychic mechanisms and the automatic external responses that result from these patterns.

2.4.1 I am aware that tracking, exploring and processing this inner world, what is sometimes called mindfulness, can be very beneficial to my therapeutic progress. The little knowledge I have gained, thusfar, over several decades, about these patterns and processes has given me a pathway to being proactive and it has helped me create a better life. It is also an ongoing process that may quite probably never end. Taking charge of one's life, which this account is attempting to put into words, involves risk because it means confronting a diversity of open possibilities. My present BPD situation is not set in cement.

3. Taking stock of my strengths and weaknesses and making deliberate efforts to bring my behaviour patterns into harmony, balance and full development is a lifelong journey. Some encounters in life demand what we are equal to, what our nerves can handle. Over the course of a life-time, though, we experience many encounters which we are far from equal-to, which are simply beyond our capacity to handle. We can call this experience life’s tests and some of these tests we fail; some relationships are lost; they end due to our own behaviour; some verbal exchanges are far, far from adequate to the situation. This is only saying the obvious.

3.1 My will often seems to be drained; at the age of 69 I often feel as if I am starting all over again. Sometimes I feel like giving up. Is there any point of fighting a battle I am going to lose? Accepting what I cannot change, changing the things I can and having the wisdom to know the difference, as they say in AA, still keeps me busy in life. I often feel like I am or I have become a burnt-out case. I yearn for release from this earthly life. I have often been a burnt-out case in the past and even now, as I write the 15th edition of my BPD story, I am only too aware that, although the in extremis aspects of my life are being contained for the most part, my BPD story is far from over.

OTHER DIFFICULTIES

1. The Physical and Psychosocial:

1.1 In 2002 I was diagnosed with chronic obstructive pulmonary disease(COPD) or emphysema which gives me a shortage of breath when I exert myself even mildly. By 2014 this COPD had moved to "phase 4". Several million people die globally from this illness each year and by 2030 COPD will be the 4th leading cause of death worldwide. There are a range of bleak statistics, but it is not my intention of discussing this medical problem in any detail, only insofar as it relates to my BPD. My form of COPD is mild as was indicated by several spirometer tests for COPD, a test I took twice between 2002 and 2012. My COPD probably originated in: (i) my smoking an average of one package of cigarettes every day from the age of 20 to 50, 1963/4 to 1993/4, (ii) growing-up in a household where both parents smoked and (iii) working in an environment in which others smoked for 30 years(1963-1993). The onset of this tobacco habit coincided, coincidentally, with the clear onset of my BPD symptoms, 1963. I did suffer from a mild RSI and various other maladies in addition to COPD, some of which I treated with exercise, thus lessening their overall effects. These several medical problems exacerbated my remaining BPD symptoms and I have outlined them in appendix #4 below.

1.2 In the last 15 years 2001 to 2015 it has become by degrees more difficult for me to engage in any physical activity for more than short periods of time in excess of: (i) a few minutes of domestic work like vacuuming, or (ii) half an hour of walking. I was informed by my GP in 2002, and I have read in the relevant literature that with regular/daily aerobic exercise this few minutes could be increased. My Chronic Obstructive Pulmonary Disease(COPD) or emphysema can be improved in the process, although it can not be eliminated. By 2012 I was swimming on average once a month for an hour in a local indoor swimming pool and found I did not tire as quickly as when walking, running, or doing domestic work.

1.3 Going forward researchers are seeking to better understand the exact ways in which COPD elevates risk of mental impairment. The ways in which COPD might affect mental functioning are probably complex and varied. As COPD progresses, "oxygen and gas exchange becomes more and more compromised, so that at the more severe end of the spectrum you see people who are on oxygen supplementation all of the time. The presence of COPD might imply that the brain is just not getting as much oxygen as needed. Seniors with chronic obstructive pulmonary disease (COPD) have an increased risk of developing mental decline, especially thinking problems without apparent memory loss, a new study suggests. This diminished brain function -- called "nonamnestic" mild cognitive impairment -- was significantly more common among older adults with COPD than those without the disabling respiratory disorder, according to the study of more than 1,400 adults.

1.4 Carotid artery wall thickening increases in older COPD patients compared with control patients with normal lung function, so a 2012 study found. The carotid artery is the large artery in the neck that carries blood to the brain. COPD was an independent predictor of the presence of plaques with a lipid core and the carotid artery in COPD patients is more prone to rupture. Patients with this progressive lung condition, COPD, are more likely to have vulnerable fatty plaques which increase their risk for stroke. This was a statement of the researchers, Dr. Bruno Stricker, professor of pharmaco-epidemiology at the Erasmus Medical Center in Rotterdam, the Netherlands.

1.4.1 In the case of social interaction for more than about two hours, I now find that I can only take part in stimulation of this type for 2 hours or less without my level of social efficiency decreasing, my social interaction skills degenerating and fatigue setting in. I have also kept a database(see appendix #4 below) of information on: (a) my visits to GPs and psychiatrists since 1999 with an outline of the several medical problems and treatment regimes in the many aspects of my health as well as (b) aspects of my health since 1980 when I went on lithium, like weight gain(80 pounds from 1980 to 2014), but it is not my intention to discuss any of all of these problems here--only to the limited extent that there is a direct relationship with my BPD, as is the case with COPD.

2. These two activities, the physical and the social, if taken in excess of the time limits I have indicated above, and if necessity has required that I do, it imposes a strain on either my physical or social capacities and sensibilities. I’m not sure how much of the above is related to the BPD and how much is just the natural result of moving through the middle years(65-75) of late adulthood(60-80) in 2014. With fifty years of a working life also behind me, 1955 to 2005; with PT and most volunteer work also behind me by 2005; with no desire to take part in most of casual and voluntary work’s many forms anymore; with decades of struggling with various features of SAD, P, D, MD and BPD and the occasional episode I have described briefly above, I feel as if the years from, say, 1955 to 2005, a half century, have slowly and insensibly removed many of life’s juices from my being.

3. These years I refer to above did not remove all my juices, though, thankfully. I enjoy reading and writing, eating and drinking, socialising to a minimum and watching a little TV-about 1 to 2 hours each day on average. The ravages of my disorder, if I carefully manage and monitor my activity as I have already indicated, are not experienced. On average, say, since my early retirement in 1999, I lose control and get angry once every two years. From the age of 55 to 71, this over-the-topness has decreased to, perhaps, once every 18 months. But the tiger of anger is still something I must watch, as I have for more than 50 years: 1963 to 2015, the age of 19 to 71.

I need to push the envelope of exercise more than I have done in the 15 years since I retired(1999 to 2015) in order to simply maintain better all-round health. The effects of my medication regime and my enthusiasm to write and read tend to deplete both my energy and my desire to be physically active, but there has been a slow and incremental improvement in these retirement years.

3.1 For the most part in community life I rarely talk about my BPD and most people who know me have no idea of my medical history, or the difficulties that I have lived under physically or psycho-socially. Most people have a domain of private experience which they keep to themselves for the most part and so this is not of itself unusual. We often, if not usually, have little idea of the inner battles that others go through in life. I have for many years regarded my difficulties as part of my own spiritual battles in life. They are difficulties that have largely slipped into a low gear in the last several years, since being stabilized on my recent medication package. These symptoms do not trouble me significantly except in the ways I have indicated in the above paragraphs. As I say, this seems especially the case with the two medication packages I have been on, firstly, in the five-and-one-half years(5/07 to 11/12), and secondly, my latest regime of seroquel and effexor(4/12 to 8/15).

3.2 I should mention that a certain spiritual attitude which has been part of my belief system since the 1950s has helped me more than I can myself really appreciate. This is especially true of the attitude to tests and difficulties in life which the Founder of my religion, Baha’u’llah, says are often “like fire and vengeance but inwardly light and mercy;” or as the old English proverb puts it more colloquially: “the gem cannot be polished without friction.” An attitude of fighting one’s own spiritual battles without giving vent to them verbally, an attitude of suffering in silence, or what in Australia is often called the quiet battler mentality, has also been part of my way of looking at life. And it still is. I could express my psychological approach in Adlerian terms and especially the terms described in Erik Blumenthal’s The Way to Inner Freedom, One World Publishing, London, 1988. I do not intend to outline the philosophical or sociological bases of my approach to this disorder in particular or to life in general

3.3 Bahá’u’lláh is the Prophet-Founder of the Baha’i Faith. There is so much I could say about my religion and its relationship to my experience of BPD but, like other possible tangents to the central theme here, I do not give it any more emphasis than a host of other possible tangents to the main storyline. A general Bahá'í attitude to psychiatry is as follows: "There is nothing in our teachings about Freud and his method. Psychiatric treatment in general is no doubt an important contribution to medicine, but we must believe it is still a growing rather than a perfected science. As Bahá'u'lláh has urged us to avail ourselves of the help of good physicians Bahá'ís are certainly not only free to turn to psychiatry for assistance but should, when available, do so. This does not mean psychiatrists are always wise or always right, it means we are free to avail ourselves of the best medicine has to offer us."(Shoghi Effendi,The Unfolding Destiny of the British Bahá'í Community, p. 248)

3.4 But even the wisest of advice, the finest of philosophy and the most practical of alternative and specialized treatments does not and will not remove all of our suffering, mine or humanity’s. Indeed, it is my view that suffering may just be part of the critical axis of our life, mine, others and society’s. If one can eliminate some of the suffering in one’s life it seems to me only natural to do so and this account is the story of the elimination of some, if not most, of that suffering, at least as it relates to BPD. But however one views suffering, it comes to us all. This account does not deal, as I say, with the philosophical and largely religious aspects of my struggle with BPD nor the wider psycho-social aspects of my tests and difficulties except in a few broad strokes.

APPLICATION OF THE RECOVERY MODEL

1. In the last decade or two, perhaps as far back as four decades to the 1970s, there has developed in psychiatry and psychology what has been variously termed a self-regulatory, self-diagnostic, illness-identity-and-monitoring model aimed at one’s personal ongoing treatment, care and recovery. It is a program that involves the client, much more than programs of treatment ever did before, in developing and drawing on what are sometimes called the evidence-based skills of mental health consumers. These skills are applied to and in a manner consistent with, the particular disorder. The consumer, the client, becomes their own doctor but this, as one can appreciate, is no easy achievement and the literature on the subject is extensive.

2. Using Ivan Goldberg’s Goldberg Bipolar Screening Quiz I scored 36 to 50 which is on “the moderate to severe symptoms” part of the scale.

3. It is argued that this Recovery Model is based on: (a) the evidence-based skills of mental health consumers; and (b) the provision of an integrative framework combining both a description and analysis of: (i) the evidence-based practice of these consumers and, in my case, the practice and skills of certain significant others in my life; (ii) manageable and modularized competencies relevant to case management and psychosocial rehabilitation contexts; and (iii) a greater recognition of the subjective experiences of consumers. The importance of one’s GP and psychiatrist using evidence-based treatments and not having an anti-science bias is also crucial.

4. The above summary of this Recovery Model which I have just outlined is itself a complex mouthful of words, to say the least. There are many verbal and written mouthfuls, medical jargon if you will, in this field of mental illness(or mental distress to use a term that is often come to be preferred in recent years), as I have indicated before in this statement, and they keep the sufferers of this and other mental disorders as busy as little beavers trying to come to grips with the terminology and its associated mystique. The mystique involved in mental illness or, as I say above, mental distress, is a mystique in some ways not dissipated, but curiously reinforced, by all the new knowledge in this last half century or so.

4.1 This recovery model puts the onus on the people with the disorder to work out what is their best way to cope and to survive in society, given the conditions of their illness. Such individuals must work out the techniques and strategies for day-to-day living. Sometimes knowing more helps but often, too, as the Danish proverb puts it: “a handful of patience is worth more than a bushel of brains.” Sufferers from BPD often lack that in-built patience due to their emotional imbalances. They often also lack that ‘bushel of brains.’

4.2 When the feeling of paranoia regarding my symptoms comes over me, I say to myself “something needs to change.” I now have many early warning signs that I can act upon that help me avoid situations which produce negative and inappropriate behaviour and interaction with others so that I can remain healthy and happy and fulfilled. I have action plans to respond to the early warning signs. Without the insight that BPD has forced me to acquire I may be like some people I know who get blinded by some stress that appears out of the blue. Without the insights I've gained I would be damaging the relationships that are important to me. I might be walking in a life journey of negative habits, of personal convenience with their attendant social consequences and problems instead of an examined life of choice which is fulfilling.

4.3 With each individual BPD is idiosyncratic; individual consumers of mental health services must work out the pattern of their disorder if there is one. In my case, in my BPD, is the pattern a rapid cycling BPD, that is, does it have four or more episodes in one year or do I experience a bout of depression at one moment with extreme giddiness the next, with no lull in between? Such a switch is considered as the worse type of BPD. This pattern is also known as biphasic cycling. I have never had either of these typicalities. Each BPD sufferer must work out what is best for them in terms of: (a) the mental health services and specialists they require and (b) what life activities and lifestyle are appropriate for them within their coping capacity in life’s day-to-day spectrum. This, too, is a complex question and I don’t want to dwell on it unduly here. It is my hope that my story may help others to work out their own particular regimen of treatment programs and their daily coping tools.

4.4 There is no single answer to the question how does a BPD sufferer cope. Sometimes the sufferer copes successfully and moves on and other times the illness takes over and leaves behind a path of destruction. One of one’s goals is to have a Skills Toolbox to reach into and use in any situation. While the basic principles of coping are the same, everyone has to work out how to apply them and that makes the principles somewhat ‘iffy.’ There is a need to avoid stress and find balance. How the person practices actual skills and conquers situations may differ completely. The process for me is still a work in progress, as they say.

4.5 The question of how to cope deals with so many variables that the question of how anyone is expected to master a technique is partly answered by having support, not going it on one’s own, understanding one’s needs and making sure they are being met. I have written this account in the hope that (a) I can meet the challenge of filling my Coping Tool Box with skills, ideas, and plans of action and (b) my experience can play a role in helping others. That is why I am prepared to share the story of what works for me here in this lengthy document. In the process readers may learn new possibilities and leave feeling understood and supported. One can but hope.

5. I have not developed, nor has it been my intention to do so, a comprehensive treatment plan for others to manage their BPD successfully. This hardly goes without saying. During my lifetime I have needed something that worked for me personally. I did not draw on a cookie-cutter idea used for all people with the illness, although my focus on medications has certainly helped me to simplify this complex experience. Some sufferers with BPD develop their own management system to deal with their disorder, to cut the number of their symptoms and to live a more stable life; other sufferers put their hands into the arms of professionals to work out their BPD treatment program.

5.1 Research by readers on the internet will reveal a number of systems that BPD sufferers use. Readers here will find no such system only the slow working out of regimes and changed packages of treatment over many decades by one person—namely me. One cannot remove a fly from a friend’s forehead, as an old English proverb says, with a hatchet, an axe or a hammer or, I might add necessarily, with 75,000 words on an internet site. Sometimes all one can do is let time take its course in one’s own dear life and the lives of others.

5.2 The view that a person’s vulnerability to developing a major affective disorder is genetically transmitted and neurochemically expressed has been strengthened in the years since I have gone off lithium at the turn of the millennium in 2001. The development in this orientation to BPD has unfortunately been accompanied by a philosophy that drugs and various physical/body/somatic therapies offer the best and sometimes the only choice for treatment. This view of what comprises adequate treatment is sometimes short-sighted and, indeed, it may be in my case. I have adopted a strict adherence to a purely psychotherapeutic or purely pharmacological treatment strategy. If the human genome project comes up with a treatment regime that is an improvement on my present medication package, that will result in an obvious amelioration of my present condition, I will change my present treatment but not for any other reason.

5.2.1 Although there is some evidence to support the idea that pharmacological treatment alone is not sufficient to prevent relapse, I feel more secure on my new cocktail of medications. Relegating this disorder to the realm of a physiological disturbance that requires medical treatment alone is often considered a serious clinical oversight and a gross scientific presumption, similar to the earlier psychological oversimplifications and prejudices that compounded the difficulties that have inhibited the development of multi-dimensional treatment approaches. However true this is, though, I am hesitant to go off my medication. Any movement in some new direction will only be taken after further consultations with my psychiatrist in the years ahead, the middle years(65-75) of my late adulthood(60-80).

5.2.2 The most convincing scientific progress in psychiatry in the past decade, 2001 to 2011, the first decade of my retirement from FT work, has had little to do with the many talk therapies or the many different medications now available. There has been rigorous, scientific verification that certain forms of psychotherapy are effective and especially cognitive therapy which has received much popular press. This is perhaps not surprising. One of the major insights in the modern biology of learning and memory is that education, experience, and social interactions affect the brain.

5.2.3 When a person learns something and remembers it for a long time, it's because genes are being turned on and off in certain brain cells, leading to the growth of new synaptic contacts between the nerve cells of the brain. Insofar as psychotherapy works and produces stable, learned changes in behaviour, it can cause subtle anatomical changes in the brain. Medicine is now beginning to measure such changes with brain imaging. If a person with obsessive-compulsive neurosis or depression undergoes psychotherapy—and if the treatment is successful in changing behavior—the treatment will cause a reversal in the biological markers of these disorders.

5.2.4 It is not my intent in this essay to document the history of mental illness treatment in the last half century or indeed the long history before, say, the 1950s. This is far too big a task and quite inappropriate to my aims here. I should say, though, in relation to the history of mental health problems that, until the last half of the 20th century, the treatment of mental health problems was relatively primitive and based on ignorance. For millennia the treatment of disorders In the mid-19th century was, from a contemporary standpoint, quackery. Nor is my aim to discuss the various approaches that I could have taken to my illness in any detail.

5.2.4.1 William Sweetzer was the first to clearly define the term "mental hygiene", which can be seen as the precursor to contemporary approaches to work on promoting positive mental health. Isaac Ray, one of thirteen founders of the American Psychiatric Association, further defined mental hygiene as an art to preserve the mind against incidents and influences which would inhibit or destroy its energy, quality or development.

5.2.4.2 An important figure to "mental hygiene", would be Dorothea Dix (1802–1887), a school teacher, who had campaigned her whole life in order to help those suffering of a mental illness, and to bring to light the deplorable conditions into which they were put. This was known as the "mental hygiene movement" Before this movement, it was not uncommon that people affected by mental illness in the 19th century would be considerably neglected, often left alone in deplorable conditions, barely even having sufficient clothing. Dix's efforts were so great that there was a rise in the number of patients in mental health facilities, which sadly resulted in these patients receiving less attention and care, as these institutions were largely understaffed.

5.2.4.3 At the beginning of the 20th century, Clifford Beers founded the National Committee for Mental Hygiene and opened the first outpatient mental health clinic in the United States of America. The mental hygiene movement, also known as the social hygiene movement, had at times been associated with advocating eugenics and sterilisation of those considered too mentally deficient to be assisted into productive work and contented family life.

5.2.4.4 Nor is my aim to discuss the various approaches that I could have taken to my illness in any detail. My intention, as I pointed out in my introduction, has several purposes among which is to help those with BPD: (a) to accept the idea that they have a medical a clinical disorder that may be recurrent and that produces symptoms that affect: mood, self-esteem, thinking, speech, activity, sleep, appetite as well as social and sexual behaviour; (b) to identify and label the specific symptoms that occur in their own lives; (c) to facilitate their acknowledgment that their most recent behavioural orientations and/or episodes of BPD can have an impact on the way they and their family members view that BPD; and (d) to identify and describe any change in their attitudes toward others and in the pattern of their relationship with others during and after an episode of BPD and during the long story that is their life.

6. Ways Mental Health Professionals Increase Misery in Suffering People

6.1 Preaching Positive Psychology Attitude-Adjustment Approaches to the mentally-ill and trauma and abuse victims. Such problems come in many forms—physical, emotional, verbal, nonverbal and neglect—all imparting the message: You are not worthy of respect and caring. While no small number of Americans have been traumatized by abusive parents or spouses, many more are financial victims of the abusive authority of the ruling corporatocracy, comprised of the wealthy elite, giant corporations and their politician collaborators. The trauma and shame of chronic abuse is painful, and mental-illness presents a host of problems. One normal human reaction to overwhelming pain is depression, which is really a “strategy” for shutting down overwhelming pain. Whether one is abused by a parent, spouse, or the corporatocracy, the pain of it can be anesthetized by depression, drugs, and a wide range of diversions.

People beaten down into a state of immobilization do not need positive-thinking advice, as they routinely know what they should be doing but lack the energy to take constructive actions. Condescending advice, which assumes inaction stems from ignorance, creates only more pain. Instead, people need compassion, love, and various kinds of support.

The majority of those in serious economic difficulty have every reason to have anxiety over financial loss, as many are already suffering or on the verge of suffering from unemployment, underemployment, a house underwater, staggering student-loan debt, and other financial nightmares. In hard economic times, many people are afraid of losing their jobs or savings. Most people in financial misery are not in that state because they are stupidly indulging their fears. Debilitating financial anxiety is often a natural state.

6.2 Modern psychology has a word that is probably used more than any other word in modern psychology. It is the word “maladjusted”. . . There are certain things in our nation and in the world which one should be proud to be maladjusted. . . One should never adjust oneself to economic conditions that will take necessities from the many to give luxuries to the few. One should adjust oneself to the madness of militarism, to self-defeating effects of physical violence. There is need for a new organization in our world: The International Association for the Advancement of Creative Maladjustment.

6.3 The evidence shows us that while the public may assign less blame to individuals for their biologically-determined mental illness, the very idea that their actions may be beyond their conscious control can create fear of their unpredictability and thus the perception that those with mental illnesses are dangerous. . . .leading to avoidance.” The authors believe that, “Biological explanations can also instill an ‘us vs. them’ attitude, defining individuals with mental illness as fundamentally different.

7. There are many other more specific purposes which this long essay can serve both for me and for others in addition to some of the general purposes I have already indicated. I will list several of them here before concluding this lengthy account. It is my hope that this essay will assist:

1.       the person who has BPD and their carer in being able to examine the changes that occur in the usual care taking roles during: (a) episodes, (b) during changes in medication and (c) during the overall constellation of behavioural patterns of the person with BPD.

2.       in helping BPD sufferers in understanding that affective disorders are familial disorders and that they affect others in the family. There are many diagnostic difficulties, difficulties for both the doctor and the client, encountered not only with the early-onset of BPD and first-time episodes as well as with long term accounts especially during medication changes.

3.       in explaining the potential advantages and risks of preventive treatment, as well as of no treatment, from the time when the first acute episode is brought under control to the end of life, a long story in analysis, diagnosis, description and treatment.

4.       in explaining the importance of long-term monitoring, including laboratory-blood tests and in encouraging the family to share in the decision to initiate or alter maintenance treatment.

5.       in teaching the family to distinguish medication side effects and the symptoms of the illness. Note: The term mental distress is often a preferred term to mental illness

MY WIFE'S ILLNESS

1. Physical:

1.1 My wife Chris, who will be 70 years of age in August 2016, also has not been well since 1970. That was the year her second child was born, and four years before I met her. She suffered from post-natal depression and, when I first met her in 1974, she was still suffering from this disorder. This was her first major episode of post-natal depression. She had a second bout in 1977 with the birth of our only child, but the medications she took were very helpful. In 1982 we moved from Tasmania to towns north of Capricorn in Australia’s Northern Territory and Western Australia, and stayed there from 1982 to 1987. Although she, too, has a long history of different kinds of problems which I won’t go into here, more recently she has been diagnosed has having an underactive thyroid, and more recently still auto-immune disease. She is taking thyroxin and, after 25 years of the doctors not knowing what the cause or cause/s of her physical problems were, she is finally getting some accurate diagnosis. But there is little she can do about her auto-immune disease which is an unsatisfactory state to be in. There is, as yet, no treatment from the medical-health world. I will report on any major improvement, amelioration, of her condition, at a later date if, indeed, her health improves. It certainly has made the domestic scene difficult for both of us in some ways.

1.2 Chris’ symptoms in the past have included: dizziness and nausea, back-ear-and-eye ache, headache and some two dozen other symptoms that we have put down on paper to try and monitor on a daily basis and to try and find some patterns. Sometimes, with the aid of steroids or some new drug, or some alternative medical treatment like clinical psychology, she seems to recover for a time, but her symptoms have eventually returned, sometimes mildly and sometimes not-so-mildly. I encourage readers to read-up on the subject of the complexities of auto-immune disease.

1.3 I often feel that my wife's battle is and has been far worse than mine. She and I live in hope, as I indicated above, that the thyroxin will continue to give her renewed physical health, energy and optimism to help her deal with hypothyroidism. New problems of hernia and, in August 2010, a hysterectomy, have come into the picture but, as I have indicated, I do not want to do more than provide a broad-brush-stoke on my wife's difficulties. Her gastroenterologist says she has a mild case of fibromyalgia.

1.4 I could also deal with the difficulties of other family members, close friends and those in my society that have impinged in various ways on my experience of BPD. But, again, these aspects of my life are essentially tangential to the main thrust of this account.

1.5 Perhaps the advantages of my wife’s ill-health, if there are any at all for me, are that: (a) they have allowed me to focus on her problems and to talk about her problems when the subject of health and fitness comes up in our personal and community life as it so often does, and has and will do in the future as long as she continues to suffer from her illness.

1.5.1 My wife’s many health difficulties over the years have helped keep the focus off of my own disability. I can talk about my need for exercise and diet, sleep or one of many other needs, thus avoiding a detailed account of and reference to my own disability and its stigma. People’s general disinclination to discuss BPD when I bring it up if, indeed, I bring it up at all, can more easily be simply dealt with by shifting the discussion to my wife’s illness and its symptoms and (b) her many years of coping have provided me with an example of stoicism that far exceeds my own and when suffering from some degree of discomfort I often think of her and her stamina in the face of ongoing physical discomforts of many years.

The same principle applies to the problems of other family members and of friends and society in general. There is always lots of stresses and strains, problems and tests that individuals in my life and society in general has to deal with that helps to keep the focus off me.

2. My many years of experience of BPD tell me the main reason for people’s disinclination to discuss BPD is an inability to know what to say, among other reasons which I don’t want to go into here. Consequently, people have little idea of the physical problems I face and much more of an idea of my wife’s problems. I don’t mind this for I am not particularly interested in talking about my disability. After 71 years, or perhaps 40 years, depending on how the aetiology of my illness and the onset of its major symptoms, is defined and described, it has become somewhat tedious in the telling and the thinking. I think this has been part of my motivation for writing this account: to put the story on paper and, in part, to put the narrative to bed given the fact that, for the most part, it is so difficult to express in the social domain. It is well-known that people with BPD are disinclined to talk about their problem in public. Such a situation has the disadvantage that people have little idea of the battles faced by sufferers of BPD. When all is said and done in life anyway, we all face our battles alone—hopefully with a little help from our friends as John Lennon and Paul McArtney, as well as the inimitable Joe Cocker and others, used to sing over forty years ago.

3. This lack of public admission or opening-up can have and has, though, a number of disadvantages. I have a core of friends with whom I can share a broad range of intimacies. Mostly, though, these friends do not tend to inquire and I do not tend to expose these battles, not now nor in the past, except to a limited extent. I have little need to ‘dump’ on people, as we used to say, not after all these many years anyway. On occasion, when it seems appropriate and with encouragement I do open- up—usually in writing. In the last several years, in the years of this new millennium, 2001 to 2015, I have been ‘coming out,’ as they say, but mostly on the internet at mental health sites. In the day-to-day round I keep a lid on the subject for the most part.

PSYCHO-SOCIAL FAMILY

1. My wife has a story here as long as your proverbial arm but to dwell on it, even to describe it briefly, in addition to what I have already written, would lead to one of the many possible tangents and their prolix labyrinths. I could go down many burrows as Alice did in Wonderland as I go about writing this statement, but I shall stay with the clinical, the medical-descriptive, focus on my experience of BPD.

CREATIVITY

1. Writing:

1.1 When I finally came to accept lithium without any mental reservations by the early 1990s; when I began, too, to see the end of my teaching career on the horizon by the mid-to-late 1990s and what I hoped would be a coincidental reduction in the various forms of frustration that I had experienced in marriage, in my career and in my community life in many and complex ways for decades, at least as far back as the 1960s---I began to write poetry a great deal. One could say I was obsessed; my wife certainly would use that word and I have come to accept that word as a realistic description of my behaviour, especially now after 20 years of extensive and intensive writing: 1994 to 2015. I have been retired from FT, PT and volunteer work for the last 9 years, and I now devote all of my waking hours when possible to reading and writing, poetry and publishing, research and independent study.

The drive, the passion, to create never seems to leave me and other activities, domestic and social, serve to provide a useful backdrop, respite, diversion and alternative, coping tools and possibly crutches, to the constant demand that comes from my inner, my psychosocial world and the philosophico-religious assumptions at the centre of this world. But this creative drive is not in the extreme form that is sometimes reported by sufferers of BPD who, without medication, say that their creative urges would literally push themselves from within until their muscles in their chest and rib cage were torn! Or, as the writer Mark Vonnegut puts it half-humorously and half in a self-deprecating tone: "I have so many original thoughts I have to take medication for it."

1.2 Phyllis K. Peterson the author of Assisting The Traumatized Soul Healing the Wounded Soul and The Heroic Female Spirit quotes her psychiatrist as saying that: “when I was studying to become a psychiatrist, there were three known types of bipolar. Now there are 82!” at: Bahá’í-mental-health@yahoogroups.com, 7 June 2008.

1.3 In an analysis of 520 eminent American women, J.C. Kaufman found that poets were more likely to have mental illnesses and to experience personal tragedy than eminent journalists, visual artists, politicians and actresses. He dubbed this "the Sylvia Plath effect" after the noted poet who had depression and eventually committed suicide. The findings appeared in The Journal of Creative Behavior (Vol. 35, No. 1). There are many other poets who had BPD and committed suicide: Anne Sexton, Sara Teasdale, and Sara Kane, among others. The complexity of Sylvia Plath’s experience of BPD is analysed at this link. I site this link here mainly because my own efforts to build-up a description and analysis of my experience of BPD have not been easy. This analysis of Plath’s BPD and my analysis are, from my point of view, equally complex and, in my case, continue another forty years beyond Plath’s. This is the link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC539515/

1.4 The demand to create is relentless, obsessive, compulsive and disinhibited, but, on the whole this demand exists as a paradoxically relaxed and energetic activity: “emotion recollected in tranquillity,” as the poet Wordsworth once put it. To some extent my writing is at the manic/hypomanic end of the manic-depressive continuum, but it is the end of that spectrum that has been treated and normalized so to speak. My medications, both before and after taking lithium, do not seem to have affected my creativity and this has been especially true on the lithium replacement package of medications after 2001, sodium valproate (NAVAL) and first the anti-depressant luvox(fluvoxamine) and then its replacement effexor(venlafaxine) in 2007. Both of these anti-depressants are useful for dealing with my OCD.

1.5 Many people without BPD create much more extensively than I do. Creativity is found in the temperaments and personalities of all sorts of people and I do not want to over-emphasize or accentuate its presence in people with BPD.

1.5.1 In several studies, University of Texas at Austin psychologist James Pennebaker, PhD, has found positive health and mental health benefits from writing--but only when the writer crafts a narrative or makes connections between thought and feelings. J. C. Kaufman states that poets may not garner the same benefits from writing that other writers do because poems seldom form a narrative. It may case, though, poetry is highly narativistic. Being into poetry is a real tough way to make a living. There are very few jobs that have a higher rejection rate. By the time I was writing poetry seriously in the 1990s, I did not need to earn a living by writing.

1.5.2 I have never been able to write during depression and, once lithium stabilized my moods back in 1980, writing began to flow incrementally and, in time--by the 1990s--copiously. Creativity in people with BPD, it is sometimes argued, stems from mobilizing the energy that results from negative emotion and to initiate some sort of solution to their problems. Discontent, to put it another way, can be the mother of invention for some BPD sufferers. To put this yet another way: discontent can be adaptive or compensatory because it can spur a person on and force the use of his imagination and, in the process, help him ride out the storms of life. If there are genes for creativity and BPD the research has not indicated it thusfar.

1.5.3 From at least 1991 until this year 2015, nearly a quarter of a century, my literary output has been utterly phenomenal, at least from my point of view. I could never have predicted it in the first 50 years of my life while I was still employed. To describe the writing process and creativity in general in more than the cursory manner that I have here would take me into another one of Alice in Wonderland’s borrows where I do not want to go and where I would take myself and readers away from the central theme here—this BPD.

1.5.4 I would like, though, to extend this section on the theme of creativity, in relation to my BPD account by making a brief comment about Beethoven. His music, it is often said, can describe the sometimes abrupt changeableness of BPD moods and their fleeting thoughts. In addition to Beethoven’s serious chronic physical illness, he suffered from paranoid schizophrenia much of the time. His glory one writer states is, in part, that he was able to arouse the paranoid in all of us through his music. The insane delight of murdering our enemies or achieving kingship over kings, that is the message of Beethoven’s Fifth Symphony. While most of us have such feelings of paranoia or extremities of mood and passion fleetingly, on brief occasions, Beethoven endured such feelings for years at a time and was able to sustain them in order to produce many a ten minute sonata movement. Of course, neither he nor we actually murder our enemies. Instead we create. He composed music. I write.

1.5.5 Composers such as Mendelssohn, Liszt and Brahms had ideal feelings which progressed as they created but, along the way, even they matched Beethoven in gleeful conquering frenzy. There is a frenzy in my creativity but it is nothing like Beethoven’s. My medications take both the psychological pain and the frenzy away, at least for the most part. I am happy for that, although it took me at least a decade to fully accept this process as I have already described earlier in this lengthy essay. St. Augustine once wrote in his Soliloquies: “The greatest evil is physical pain.” I find this to be true in both the physical and the psychological domains but the pain must be at a certain level, that is, beyond a certain level of intensity. Over the decades I have developed a tolerance for psychological pain but not for physical pain. Medicine generally has regarded pain as a signal of physical injury to the body despite evidence contradicting the linkage, and despite the exclusion of vast numbers of sufferers who experience psychological pain. By broadening our concept of pain and making it more inclusive, we can better accommodate the basic science of pain. We can also recognize what is already appreciated by the layperson—that pain from diverse sources, physical and psychological, share an underlying felt structure.

1.5.6 s One’s instinctive tendency to see pain more broadly, as a category that incorporates both physical and psychological varieties, may be more enlightened than the expert’s narrower conception. Perhaps there are good reasons for speaking of pain in the setting of grief or depression or schizophrenia or divorce or the nonphysical suffering that accompanies illness. Now pain of any kind is notoriously difficult to express. There are problems conceptualizing the experience because it is perceptually inaccessible (we can’t see or touch pain) and because, unlike other inner states, it is not always linked to external objects that we can see or touch (like the person who makes us angry. I am arguing here neither that psychic distress is any less real than physical pain nor that somatic complaints can accompany psychiatric illness—in fact, 50% of depressed patients report symptoms of physical pain (Katona et al. 2005)—but that psychic distress can itself be painful in a meaningful sense, that it can be phenomenologically akin to physical pain &, therefore, should be categorized under the same rubric. As a result, one is forced to think about pain indirectly, through metaphor: we imagine a more knowable object linked to the pain and then speak of the experience in terms of that object. The subjective evidence for the existence of emotional pain is compelling, especially since there is no objective way to verify and characterize someone else’s pain.

A PERPETUAL STATE

1.Many famous people have success that is attributable to them being in a perpetual state of bipolar hypomania and, in some cases, mania. I often feel, with my final medication package in 2012, I have elements of this perpetual state. Noted bipolar authority Kay Jamison PhD, at a conference in 2002, described Teddy Roosevelt as "hypomanic on a mild day." Bill Clinton, one could argue, is a walking hypomanic poster boy. If you can just find a way to keep your bipolar in the hypomanic end of the spectrum you can become very successful. Scientists now know that bipolar children and adults have too much activity in a part of the brain called the amygdala which regulates emotions and not enough in the prefrontal cortex, the seat of rational thought, a region of the brain which controls behaviours such as impulsivity, and executive function, as well as complex cognitive processes such as working memory, attention and language. The working memory is affected by emotional challenge and people with BPD have more deficits in regions of the brain involved in emotion-processing and regulation. As my wife often puts it, colloquially but in a way that summarizes the effect of my behaviour on others: "you did not think." I often seem insensitive to others, to the effect of my behaviour is having on others. This causes tension in the home and in the relationship with my wife who has to deal with me on a daily basis.

2. When a person gets upset, anxious, depressed or angry these regions of the brain---the amygdala and the right prefrontal cortex---become very active. Perhaps this is the cause of what I have often called over the years, my warrior-mentality, my application of the war-metaphor to my life. In the process of redoubling my efforts, of increasing my struggle with the battles of life, of persevering, of concentrating the forces of my personality, inter alia from decade to decade, I may have just played into these aspects of my brain, my physiological predispositions. I have no idea, really. This is just a theoretical possibility. But, if this theory is correct, it is the reason behind my apparently compulsive creativity and writing. Combined with my OCD and some of the other mental disorders that I suffer from and which I have written about in this account--like PTSD--my BPD produces, results in a somewhat fanatical edge to my present life experience. My poor wife has to deal with me and it is not easy for her. She also has her own problems and coping with me only compounds them---and her problems then impact on me even more with what might be called 'the snow-ball-effect.'

2.1 In recent research, Dr Richard Davidson, director of the Laboratory for Affective Neuroscience at the University of Wisconsin, has shown that this overactivity in the amygdala and the right prefrontal cortex which makes a person upset, anxious, depressed and angry is quieted through meditation. The left prefrontal cortex, a region associated with happiness and positivity, becomes more active. In studying meditating monks, Davidson found they had developed especially high activity in the area associated with happiness and positivity.

2.2 I still have a problem with depression, with anger, fear and anxiety but in quite different contexts and to a far lesser extent than I once had or that I have had from time to time in my BPD life. The depression has been severely cut back to such an extent that I do not regard it as a problem, at least not in any of the serious dimensions that I experienced it in the past. But anger and anxiety are different quotients. I have a degree of happiness and positivity mentioned above most of the time and especially when I am writing. The medications I now take have not removed all the deleterious symptoms of my BPD and my other disorders, but they have attenuated their negative features to such an extent that I feel as if my everyday life is as normal as I can expect.

MEDITATION

1. Perhaps if I was not on medication, if I wanted off my medication or if I wanted to be a megastar or top-performer like those listed below, I might get into the kinds of meditation and talk therapies that have become popular in recent decades. I have now been on various packages of medications for my disorders for thirty years, and over forty years if I go back to my first medication regimes in June 1968 when I was committed involuntarily to a large psychiatric hospital in Whitby Ontario. I have no desire to go off or alter my current regime. My brain activity often needs to be slowed down or dampened and when this is the case I go to bed and try to sleep. After midnight I watch TV to achieve that end, to get an increase in alpha-waves so I am told. As a writer I need a high level of brain activity to keep engaged in creativity and the writing that is a product of that creativity.

2. When I get very tired/sleepy I simply go to bed and sleep. Studies have shown that watching television induces low alpha waves in the human brain. Alpha waves are brainwaves between 8 to 12 HZ and such waves are commonly associated with relaxed meditative states as well as brain states associated with suggestibility. While alpha waves achieved through meditation are beneficial since they promote relaxation and insight, too much time spent in the low alpha wave state caused by TV can cause unfocused daydreaming and inability to concentrate.

Researchers have said that watching television has similarities to staring at a blank wall for several hours. This is not a problem for me since my TV consumption is low, less than two hours per day on average. I use TV as a sedative to create the same alpha waves as certain forms of meditation. In addition, of course, I have come to enjoy many programs in these years of late adulthood and my retirement from FT, PT and casual-volunteer employment.

3. The Bahá'í Faith, the religion I have belonged to for over 50 years, teaches that meditation is necessary for spiritual growth, alongside obligatory prayer and fasting. One of the Bahá'í writings makes the point that: "Meditation is the key for opening the doors of mysteries to your mind. In that state man abstracts himself: in that state man withdraws himself from all outside objects; in that subjective mood he is immersed in the ocean of spiritual life and can unfold the secrets of things-in-themselves."

Although the founder of the Faith, Bahá'u'lláh, never specified any particular forms of meditation, some Bahá'í practices are meditative. The sign of the intellect is contemplation and the sign of contemplation is silence—as one Baha’i writing states in a succinct manner. One of the daily Baha’i prayers is the repetition of the Arabic phrase Alláh’u’Abhá , an Arabic phrase for “God is Most Glorious.” This expression is repeated 95 times preceded by ablutions. Abhá has the same root as Bahá, Arabic for splendour or glory which Bahá'ís consider to be the "Greatest Name of God".

4. It is interesting that meditation, the kind of meditation that induces alpha waves, has already helped the following top performers:

Steve Jobs, founder/CEO of Apple
Tiger Woods, Winningest Golfer in History
Bono, Nobel Peace Prize Nominee & Singer for U2
Oprah Winfrey, Billionaire & Media Mogul
Al Gore, Vice President & Nobel Prize Winner
Howard Stern, Shock Jock & "King of all Media"
Paul McCartney, Singer, Songwriter, Beatle
Phil Jackson, NBA coach
Russell Simmons, $325 million net-worth. Simmons is a hip-hop
entrepreneur and meditation evangelist

5. Here's a list of well-known people, according to Garret LoPorto, who've already tapped into this power of meditation to reach their full potential: Jim Carey, Robert Downey Jr., Patty Duke, Ben Stiller, Robin Williams, Ludwig Von Beethoven, Francis Ford Coppola, Ted Turner, Buzz Aldrin, Peter Gabriel, Jimi Hendrix, Axl Rose, Sting, Sylvia Plath, Winston Churchill, Theodore Roosevelt, Jane Pauley, Mark Twain, Virginia Woolf.-Thanks to Garret LoPorto, CEO, Media for Your Mind, Inc. Author of The DaVinci Method. The National Alliance on Mental Illness(NAMI) can also add many people to these lists.

5.1 Then there are the multitude of people in history whom various students of history and psychology, psychiatry and medicine, literature and various humanities and social sciences assume had bipolar disorder:

1.The Old Testament prophet Jeremiah according to Harold Bloom in: “My Favorite Book in the Bible, “ in the NYRB.


2. Fame and fortune have not come my way, but the act of writing is enough of a motivator and I have hundreds of thousands of readers on the internet which is fame enough for me without having to deal with any of the negative features of celebrity. The fluvoxamine, since 2001, enabled me to work after 11 p.m. if I want to and well into the early hours of the night. Back in the years 2001 to 2004 I could work until after 2 or 3 and sometimes as late as 4 or 5 o’clock, if I desired---without the black moods. In the years after 2004 I have developed a more regular sleeping regime and am now in bed sleeping on an average of 8 to 9 hours in every 24. I was usually in bed from 1 to 2 a.m. until 9 or 10 a.m. and again for 1 to 2 hours during the day and/or evening. By March 2014, as I write this latest update of my BPD account, I am getting a good 8-9 hours sleep from 11-12 hours in bed.

3. The transition to sodium valproate had its problems; this proved to be the case after several weeks of one medication and ten days of the other. As I write this 2nd draft of the 15th edition of this narrative to cover the period up to and including September 2015, though, my sleeping patterns as I have already indicated have become more regular. My sleeping patterns in May of 2007, at the onset of yet another meds regime some 8 years ago, had become more chaotic than they had been since the 1960s; they have altered again and again over the years. That new medication package, initially resulted in quite an unsettled sleeping pattern for several weeks, but that pattern is now---after 8 years---giving me some steadiness, some settling, some routinization of habit and it seems that this new normality of sleeping routine will remain with me, at least if I stay on this most recent medication regime.

MY CREATIVITY IN A PSYCHO-SOCIAL CONTEXT

1. My creativity seems to be part of an obsessive compulsive disorder(OCD); but this is only a theory. Whatever my OCD tendencies are, I have never regarded them as requiring treatment; they have become part of who I am. I accept them, as do members of my family, as a sort of eccentricity. These OCD tendencies became more exacerbated after April 2007 when I went on the new medication regime of sodium valproate(NAVAL) and effexor. My OCD behaviours can be and are quite frustrating to my wife with whom I have to interact frequently. At the moment my wife is the only person who has to deal with/put up with my OCD on a regular basis.

1.1 Emptying the garbage many times a day, doing the dishes to keep the counter in a pristine state, squaring all the bits of paper around the house, keeping my desk and all its papers in a highly organized state are among the several, indeed, the many examples that illustrate this OCD tendency. These manifestations of an OCD were hardly manifest most of my life at least not to any significant extent. But they are now, as I say, outside the normal range of acceptable social behaviour, certainly from my wife’s point of view. Hypergraphia is a condition causing one to need to write continuously; this disorder is commonly linked to mania and epilepsy, and I might add, OCD. Some believe that the massive collection of over 800 letters Van Gogh wrote during his lifetime could be attributed to this condition. I have written much more than van Gogh and the need to write continuously is certainly present in my case. I will say no more about OCD here.

1.2 My wife was troubled by my irratic sleeping patterns for the first six months on my new medication package(5/08-12/08), an aspect of my BPD, but has come to accept them. My sleeping irregularities are a tangent to, although an important aspect of, my BPD. My psychiatrist says that, from his point of view, I do not even suffer from OCD. He, of course, has to deal with more extreme examples of its manifestation in his clinical practice. I shall, therefore, leave out further comment on this OCD. Excessive concern for sleep, its quantity and its patterns, is also a common symptom of BPD, but I shall also discuss this no more here as well since I have already written about it extensively and I will say more on the subject later.

1.2.1 The issues of career, various frustrations and anxieties, problems in relationships that we all have in one way or another, the difficulties involved in moving from place to place as I have done over the years, stresses and strains in marriage, dealing with the ill-health of my wife and the eccentricities of others in my family and place of work, while important to me and to my story in a wide variety of ways are somewhat tangential to the central theme here of my BPD. They are all tangents to the main story line. I do not want to underemphasize or overemphasize these other and important aspects of my life in this statement. They are important, but as I have often said above, they are tangents to the theme, however important they may be and to dwell on them would make the focus of this account far too diffuse. These tangential features of my life have all been, each in different, complex and mysterious ways, contributing factors to my outburst of creative writing in the last 21 years(1991-2012) or 31 years(1981-2012), if I extend this overt creativity back to my treatment with lithium for BPD(1980) and, then my first extensively published writing in Katherine in Australia’s Northern Territory in 1983.

1.2 Numerous studies have examined the link between BPD and creativity. Several studies have shown that artists and writers may have two to three times more incidences of psychosis, mood disorders or suicide when compared with people in less creative professions. People with BPD may possess a creativity that stems from their ability to mobilize energy that results, as I have already indicated, from negative emotion. In this way they initiate some sort of solution to their problems. In this case, then, discontent, it seems, is the mother of invention. Creativity and BPD may have important genetic components that are transmitted together inter-generationally as I have also indicated above. There have only been limited studies investigating this genetic susceptibility to BPD. (“Children Of Bipolar Parents Score Higher On Creativity Test, Stanford Study Finds, “ Science Daily, Nov. 9, 2005)

1.3 As a final comment on this subject of creativity and BPD I would like to introduce a note on hypochondria which is considered by psychiatry as a variant of OCD and there is some relevance of this subject to my condition. It was a relevance that first occurred to me when I came across the book Tormented Hope by Brian Dillon. This book helped me to place what I want to say here about hypochrondria in a helpful context and to fit my present lifestyle somewhere along the spectrum of hypochondria. My medications, my creativity, my BPD and my OCPD all combine in a fine, a convenient, way, to support the lifestyle my body & my mind desire, as well as the artistic, vocational and avocational purposes that I also desire. All these factors come together to provide me with a basis for my retreat from the world to find the kind of solitude in which to: (a) pursue the new avocational focus on writing that I have developed in these years of my late middle age(55-60) and late adulthood(60-70) and (b) invent, so to speak, the self I desire and need to do my new work, to focus sharply on the literary task that has come to take the central pivot of my life.

1.4.1 Dillon says that hypochondria is rooted in a desire for certainty and control in a world where both are very difficult if not impossible to achieve. To put these ideas of Dillon, this hypochondria, in another context, I have come to use my BPD and my illnesses as a critical backdrop to pursue my avocation and forge the independent life which this avocation requires given the obsessive nature of this avocation. My illnesses and disorders nurture and liberate me as much as they hobble, obsess and partially annihilate other aspects of my life. In some ways, although not entirely, my BPD and OCPD are a question of attitude. They are both a bulwark that protects me from a predatory world and allows me to have a fulfilling life inspite of my BPD and OCPD.

1.4.2 These disorders combine to provide some of my core life-structuring principles. They are real but they also masquerade in a certain sense as chaos. They help provide me with a resolve, a resolve which contains not-a-little fear. They allow me to appear on the stage of my own life in a way that I can cope. Sometimes it seems as if I am appearing on this stage in the costume of a character in a play. But it is a play I have scripted myself and in a character which is the very persona I want to be. Psychiatrists sometimes characterise the hypochondriac as a neurotic, self-critical and introverted person whose nervous system is like a radio with the volume turned up so high that the background static becomes intolerable. In addition, BPD changes the acid/alkaline balance in the blood which, in turn, produces a range of physiological and psychological effects one of which is to make brain cells behave in a more excited way. Both these descriptions have some relevance to my present state and so I include them here in this commentary on what might be called my hypothesized hypochondria.

1.4.3 Looking at the manifestations of my BPD and the general nature of my personality since as far back as the years of late childhood(9-12), 1953 to 1956, it would seem there have been two overall personality patterns. From 1953 until, perhaps, 2003, I exhibited a generally extroverted pattern. I could even term it manic. As I began to enter late adulthood, the years after the age of 60, the more introverted and depressive side of manic-depression was manifest. Part of this could very well be part of the aging process and my activity profile in the lifespan. My energies which had, for half a century, been turned outward in the main to deal with and survival in the employment world and socially--began to turn inward in the main in order to give expression to the creative side of my personality in its engagement with writing.1(1mild mania is conducive to creativity but as one progresses to acute mania the prerequisites for creativity decrease)

SOME CONCLUDING COMMENTS

1. General:

1.1 This brief and general account, at least brief in contrast to a whole book that some people write on the subject of their bipolar experience, summarizes both the long history of this illness and where I am at present in what has been a life-long battle. I think it is important to state, in conclusion, that I possess a clinical disorder, a bio-chemical imbalance, having to do with brain chemistry. There is an upset in the balance of different neurotransmitters known as excitatory and inhibitory neurotransmitters which are involved in sending signals in the brain. This lack of balance is seen as central to the disorder. Lithium and valproic acid work by restoring the balance of these neurotransmitters in the brain.

Increasing medical and diagnostic skills and knowledge since the 1950s have helped those with BPD so that sufferers are being treated better than at any time in history. With an increasing range of mood stabilisers, anti-depressants and anti-psychotic medications on the market and with the use of a range of other therapies--the perturbations of BPD have been more effectively treated than ever before.

1.2 I feel I am a success story inspite of any tendency to gloom and doom that occupies the content of this book. Every day one makes progress or goes backwards, although often what we sense is stasis. Every step we take may be fruitful or retrogressive but, again, so often it seems like nothing has happened at all. Whatever stretches out before you—and I—is an ever-lengthening, ever-ascending, ever-improving or descending path whose journey will never end until, of course, our death. Churchill said that it is this process which, far from being discouraging, only adds to the joy and glory of the climb. Of course, not all of us can be a Churchill and even that Old Battler had to fight the Black Dog and it was not always with success. It seems to me that, however unfortunate it is for you or I to be discouraged and however dismal the outlook appears, labouring serenely, confidently and unremittingly is a useful goal to shoot for—little by little and day by day—even if we do not achieve it in its entirety—and who does?

1.3 Depending on what study one reads, there are some three to five per cent of the population suffering from this illness. The extremes of this illness as I had experienced them before 1980 were largely treated by lithium carbonate from 1980 through the 1990s to 2007. But in the 1990s and into the new millennium new medications and, indeed, other treatments became available. The story of all these medications and treatments that have become available is not included as part of this account. I tried many alternatives in my efforts to obtain healing in the years from 1962 to 1980 but, by the time I retired from full-time work in 1999, I was not inclined to experiment with alternative treatments. There are many statistical estimates available from various sources, several degrees and intensities of BPD and other bio-physiological and emotional imbalances that resemble BPD but are not actually BPD. These factors that make the estimation of a specific percentage of people who suffer from this BPD difficult to tie down with a high degree of accuracy.

1.3.1 The list of alternative treatment programs is now a long one & I will not provide a comprehensive statement of these alternatives. I have tried many alternatives over the years and that list is a curious cornucopia of hoped-for solutions. These alternatives from within the fields of psychiatry and psychopharmacology and from without, from the burgeoning world of alternative medicine, each have their own story. I have taken fish oil, 1000 mg/day since 2005, with its omega-3 fats as well as several regimens of vitamin and mineral supplements since the 1960s, but I will not enumerate the list of these supplements nor the dietary and food issues that I could also discuss. For me, these are all tangential issues even though, in rich Western societies like my own, lifestyle is sedentary, one's diet is critical and stress is psychological and not physical.

1.3.2 I also leave out a detailed discussion of: (a) serotonin and dopamine levels, monoamine oxidase inhibition and its influence on opined peptides such as beta-endorphins sometimes referred to as adaptogens; (b) stimulants like nicotine among others or depressants like alcohol among others; and (c) prayer and meditation in their various forms. But I will make one general comment on serotonin levels which appear to correlate with happiness. Serotonin levels have been shown to correlate with motivation, concentration, energy, sociability, and libido, and to correlate negatively with anxiety. Too little serotonin in combination with other neural changes and we become isolated, lose motivation and the ability to concentrate, and experience increased anxiety. If we have increased amounts of serotonin present in our neural synapses we become full of energy, gregarious, and our libido increases. If our serotonin levels are mildly elevated we reportedly feel “better than ever.”

1.3.3 Since our perception of “external reality” is a construction of the brain what goes on in the brain, chemically and electrically, is crucial. Our senses are confronted by a chaotic, constantly changing world that has no labels, and the brain must make sense of that chaos. It is the brain’s correlations of sensory information that create the knowledge we have about our surroundings, such as the sounds of words and music, the images we see in paintings and photographs, the colours we perceive: “perception is not merely a reflection of immediate input,” some analysts say, “but involves a construction or a comparison by the brain.”

1.4 The prescription of lithium(1980) and the addition of fluvoxamine(2003); the changeover to sodium valproate(2007), & venlafaxine (2007) in April/May 2007 each had its own story and its problematic for periods of time in the main for less than two months each as I have described as briefly as I can above. By June/July 2007, after 7 consultations with my psychiatrist, in the January to July period of 2007, it was obvious that the new medication package was giving good results. My psychiatrist and I agreed that, unless some problems arose, I would not come for any follow-up visits. And I did not, but in April 2012 my wife and I decided that I needed to go to another psychiatrist and get a different meds. I discuss this new pkg below.

1.4.1 My latest medication package came into my life, then, in April 2012. It became my most recent cocktail, as it is sometimes called in the psychiatric vernacular. In May 1980 I had settled on lithium, just the other day it seems in retrospect, although it flowed through my veins and was part of my brain chemistry, to put it more accurately, over some 27 years ago. In the five year period, 5/07-4/12, I worked out—thanks to my new psychiatrist--a new and quite satisfactory alternative meds package. As I write this latest edition, though, in September 2015, a very new medication regime now 3 years old is still a work in progress.

1.5 Finding the right combination of meds can be a discouraging process but, thanks to the professional expertise of a psychiatrist, a clinical psychologist or, perhaps, a psychologist, assistance is available to sufferers from BPD. In my case I had a psychiatrist who had specialized for over three decades in working with people who have BPD. I feel I am on the right meds, as medications are often called colloquially. I am not inclined to tempt fate and try some other package, at least not yet. Trust and confidence in one’s psychiatrist, one’s specialist, is a critical variable in this whole exercise.

1.6 The story of the history of my medication-regime change may not be over yet even after more than four years of the last major shift to NAVAL and effexor and one year on my present medication regime of that medication package. In November 2008 I reduced the effexor level from 75 mg to 37 and ½ for two weeks and then nothing at all on 10/12/’08—with the view to resuming the 37 & 1/2 level if my behaviour warranted. The change in the quantity of anti-depressant medication, that is of effexor(venlafaxine), produced no observable change in my behaviour or symptoms until late January.

1.7 This section is devoted to one of the characteristics of mania which is the opposite of depression. I have come to call it speeding. Rather than a general slowing down of thought and activity which is a very common feature of depression, the person with mania experiences a speeding up of thought and activity. Also, with a manic episode the person's self-esteem and mood are elevated, which is unlike what happens in depression. A person experiencing a manic episode frequently encounters difficulty with relationships and problems at work, at school, or with the law. I experience, even now at the age of 68, a milder form of mania which is called hypomania and which was often called hypomania over the years. The person who is hypomanic experiences speeded-up or pressured speech, thought, and behaviours, but usually/still functions normally. Now, at the age of 68, I only speed when I have been in social situations for too long a period of time and "too long" can very from a few minutes to two or three hours.

1.7.1 The medications I take work on monoamines which are a type of neurotransmitter. While not wanting to go into any detailed chemistry of neurotransmitters like norepinephrine and dopamine, I will make a few comments here on the chemical and physiological sources of my speeding, sources connected to these neurotransmitters. Dopamine is said to increase general arousal and goal-directed behaviours and decrease latent inhibition; it also appears to increase the creative drive of a person’s idea generation. This has led some psychiatrists to what they call a three-factor model of creativity involving the frontal and temporal lobes of the brain and dopamine.

1.7.2 This feeling of speeding and/or speeding-up is also characterized by a sense of euphoria. In my case the euphoria is mild, but the intensity of activity is high: running to and fro tidying-up and engaging in much OCD activity until, exhausted, I go to bed and sleep. Blood pressure and heart rate increase as well as other components of the body’s operating system including glucose and the respiratory system. The problem with the speeding-up of my body is that, as I say, I also get a mild high, a quasi-euphoric state and a degree of sensory confusion.

1.7.3 There often follows, after a short period of this speeding-up, say as much as an hour or two, a drop in energy and extreme fatigue and, of necessity, I have to go to bed and sleep. When my head hits the pillow for sleep I can feel a rapid-firing of mental activity which I have to slow down in order to get to sleep. This process nearly always occurs, at least in the last four years, after two to three hours of social interaction. Such extended interaction often leads to inappropriate verbal output if I remain in that interaction beyond, say, three or four hours. I have developed, therefore, a desire not to engage in social activity after this time-period. The above story of my speeding has been the dominant pattern while on my new meds package: NAVAL and effexor.

1.8 I had no intention of changing the NAVAL after being on it for four years. My intention at that time, in 2011, was to remain on NAVAL until some advances in pharmacology and psychiatry come my way, until my psychiatrist suggests a change or until I feel the need for a change due to some excessive form of symptoms raising its head again. As my story unfolds and my experience under this new regime advances, I will document it here as succinctly as I can. The major negative side-effects of NAVAL were: a mild diarrhoea, drowsiness and weight gain all of which were neither serious nor debilitating.

1.9 I really feel quite and quietly exhausted from: (a) the lifelong battle with this illness and (ii) the soporific effects of my current medication package. I would prefer to continue to live my everyday life quietly and in ways that my health allows with little to no social demands. This anti-psychotic and anti-depressive medication evens-out my mood disorder and its fluctuations. I feel a deep fatigue now in my mid-sixties from a range of sources. My entire sensory-motor experience has been so various both now and over the years that long social interactions are really more than I want to bear, to engage in. I only do so as a result of: (a) unavoidable circumstances, (b) situations which are actually pleasurable but produce emotional exhaustion if carried beyond 2 or 3 hours, (c) my wife’s persuasion and (d) out of some sense of social obligation but rarely out of any desire on my part. When I do go beyond my psychological limit the consequences, thusfar in these last three years are: (a) inappropriate verbal outbursts in the form of criticism of others and (b) an immense fatigue that necessitates great quantities of sleep for the next 24 hours.

1.10 In 1999 I gave up full-time work; in 2003 part-time work and by the years 2005 most of my volunteer work by incremental stages. I have had seven years now, 2005 to 2012, virtually free of all forms of work/employment. In the years 1999 to 2005 I took part in a wide range of volunteer activities from holding a radio program, to participating in a small singing group, to teaching in a school for seniors here in George Town Tasmania, to organizing a series of public meetings, to activities that are part and parcel of my religious and social life. These served as a type of step-down transformer after many years of 60++ hours/week in employment and community activity.

1.10.1 Now in September 2015, except for some volunteer Baha’i work largely involving writing, participating in small public and social meetings of two to three hours maximum duration, and doing the inevitable voluntary and necessary domestic activity in my home, my volunteer work has ceased. As I have pointed out above, my social interaction as well as my simple desire for social activity, have decreased markedly. My verbal skills and behavioural capacities still exist but only for short periods of time.

1.10.2 Occasionally I must attend to social, family or Baha’i functions and obligations of more than two hours length, as I say, but such situations are rare and I am usually successful at keeping such occasions to a minimum. When I must spend 4 to 6 hours in some social activity the result is total exhaustion and a determination “not to do that again.” Occasionally, too, when friends or family members stay in our home for a day or more I simply (a) take myself off to my study or (b) go to bed when the social interaction gets too demanding. It has taken several years to learn to do these things to protect both myself and others from the negative verbal behaviour which raises its ugly head after too much social demand/interaction.

1.10.3 I seem to have 2 settings in interpersonal situations: off and on. I keep my mouth shut and be invisible or talk and talk and talk. I avoid parties and group gatherings because I get overstimulated and often take over conversations. Medication and knowing when to shut-up or simply not engage , I am confident, helps me find the middle ground.

1.11 My short bursts of writing and reading, bursts which add collectively to some eight hours each day, are about as much as I want to handle. Other short bursts of activity, as I say, in the form of: (a) domestic activity like cleaning, cooking, ablutions, watching TV, inter alia, as well as (b) short meetings, interactions with family and/or friends and (c) various other kinds of social activities, which continue to give some variation to my life, also add up to another eight hour total. It’s a creative milieu and one with significant meaning. In some ways this milieu is more frenetic and in other ways less frenetic than it was on the lithium-luvox package and as it was for most of my years as an adult.

1.12 I have now been left in 2014 with the age of 71 some 4 months away as I write these words, after all these decades of BPD, in a quite exhausted, worn-out and enervated state inspite of appearances to the contrary. Many other people, friends and associations, have no idea of my BPD and interpret my lack of social activity, my hermetic preferences, incorrectly. They see my interaction as: (a) being quite normal or (b) having some kind of abnormality and, not understanding my BPD, expect from me what I cannot handle, cannot do without great effort, too much effort, too much debilitating effort. Virtually all of those with whom I interact have little appreciation or understanding of my BPD and its affects with the exception, of course, of my wife—and even then I sometimes wonder! This no longer surprises me for many reasons which I have alluded to at several places in this lengthy statement.

1.12.1 Except on rare occasions when I let the veil down and ‘come-out,’ as they say, the majority of those I meet are left in the dark as to my illness and, for the most part, this does not trouble me. Even then, after some degree of 'coming-out,’ the understanding of others is limited. I know from many years of experience of BPD that there is little public understanding and much stigmatization of my condition, inspite of many changes and improvements in society and much destigmatization for/of the mentally ill. This is one reason I utilize the internet to: (a) tell my story and (b) help others at over 100 sites on the world-wide-web. In the fields of art and literature and music, there is much more toleration of mental illness than there is in the rest of society. That might allow people with mental illnesses to climb the ranks of poetry in a way they couldn't have done in business.

1.12.2 I take on the inevitable and necessary domestic activities, as I have mentioned above, and my wife has become even more, what she has always been, the most critical person in my social interaction scene. Our last child left home five years ago in 2005 and my interaction pattern in my home, in my relationship with my wife, altered yet again as is the case with millions and billions of other people on this planet who go through the inevitable changes along the lifespan in their marital, family, love and relationship life. BPD sufferers in many ways experience the normal problems that are the experience of Everyman. Various domestic activities and a variety of social interaction settings are all within my capacity, as I indicated above, but for the short time periods I have emphasized above.

1.13 Now that I am retired and now that I write and read so much of the time a new-old problem has emerged and that is getting the balance right in my relationship with my wife, giving her the care and attention she needs and deserves. But that is a separate and tangential problem. Life has its tests and difficulties until the end of our days on this earthly plane and it is not my intention to describe all my life and its problems and joys in this statement.

1.14.1 Periods of physical activity must be kept short; this is necessitated, also, by my chronic obstructive pulmonary disease(COPD) which has resulted in a shortage of breath after even, especially after, a little exercise. The question of physical exercise, though, is complex. It is a separate issue in some ways which, as I have already indicated, I do not want to overemphasize or even discuss here in any detail. I was advised by my doctor as far back as 2001 to do 20 minutes a day of strong exercise, or “puffing.” But after beginning the effexor medication in 2007 I could not find the enthusiasm or energy for such a level of exercise.

1.14.2 In 1980 after I had taken on a vigorous exercise program of running for several months I had another bad BPD episode and had to be hospitalized. In the process, I became somewhat sceptical about the positive effects of rigorous exercise for me. I do hope to get back into a gym-sauna-swim program or even do more exercise around the house in the form of domestic activity like cleaning---in the months ahead, but as of March 2014 this has eventuated to only a limited extent. At the moment I follow the advice contained in a book entitled Walk! The emphasis in this book is on walking with some light exercises in the process. This is a form of exercise I have been doing on a daily basis for at least the last 20 years and, since 2007, I have added more exercises as I walk along. I also swim on average 2 to 3 times a month for 1/2 an hour.

1.15 There is much in the backdrop of my lifeline, my lifespan, which I could include in this account and I encourage readers to have a look at: (a) my more detailed narrative or memoir if they think that what I write in that longer account might be useful to them and/or (b) my medical notes from the years 1999 to 2011, if they want a more fully contextualized account, an account that gives much more of the story of my life, of which this BPD account is but a part. My memoir of 2600 pages is available under separate cover to readers. Those wanting to write to me can do so to my email address at: ronprice9@gmail.com.

1.15.1 The notes I keep from the visits to my GP doctor and my psychiatrist are found in Appendix 4 at the end of this statement. It is often advised that people with BPD have a strong exercise program especially in the morning to get rid of their excess.

1.16 When I get ill or get an infection, when I have a cold or a virus, when I am forced due to circumstances to engage in long periods of many days of social activity, as I was in April-May 2009, I feel deathly, non-functional in the extreme and the old death-wish syndrome winds its way into my psyche. Sometimes in such situations: (a) I take disprin, panadol & anti-biotics, drink plenty of liquids and stay in bed as long as I can or (b) I simply sleep as much as I can, withdraw and retreat from life’s stimulation. The message for me from such experiences is: avoid such socially demanding situations and other social conditions in which I am likely to: (i) catch a cold/virus/sickness of some kind, (ii) get emotionally and psychologically exhausted or (iii) become critical, verbally abusive, over-the-top or ‘blotting-my-copybook,’ as my wife puts it colloquially.

RETIREMENT AND ON AN OLD-AGE PENSION AT 71

1. I turned 65 in July 2009 and am now on the Australian Old Age Pension(AOAP) and the Canadian Old Age Pension(COAP). I have not worked in full-time employment for some 17 years(4/99 to 4/15) for reasons associated with this illness as well as being at pension-age beginning when I was 65. I was on an Australian Disability Services Pension(ADSP) from May 2001 to July 2009--eight years. Although I have been treated for the worst side-effects of BPD, I have little energy, enthusiasm or capacity for FT, PT or causal employment or any demanding social and community activity that entails many hours of interaction and long periods of listening and talking. A “long period of time” in social interaction(i.e. formal and informal meetings, large family/social gatherings of more than three people) had become defined, by the time I was regularized on my new medications in June 2007, as any number of hours beyond two. After 2 hours I often, although not always, lose my normal, easy-going self and become critical and verbally abusive.

2. When I unavoidably take part in such social activities, it is usually because I want to please my wife to whom I have been married for 35 years, although sometimes I take part in some community activity out of a sense of duty and social responsibility, an important part of my religious ethos, as I have indicated above. But my preference is to avoid any interaction settings that involve more than two hours of engaged activity. I have said this before in this document but, I know from experience, that this aspect of the current manifestation of this illness is often understated, little understood even by me and needs repeating to underline my point. When I tell others of this fact it is, not surprisingly, often misunderstood or simply ignored. I try to avoid complaint about my symptoms. So much of one’s life and one’s behaviour is not understood by others or oneself for that matter. This reality is part of the experience of one’s journey on this earthly plain.

3. I have written this statement for many reasons as I pointed out at the outset of this account. Initially it was for an interview with a Centrelink Disability Officer in the Department of Health and Human Services back in 2001 in order to obtain the ADSP. Since 2001 I have written many further drafts of this statement: (a) for internet purposes at mental health, bipolar and depression sites and also (b) to update that original statement because my illness is an ongoing one whose story is far from over. I trust the above outline provides an adequate information base for others to evaluate and understand my situation and/or to draw on my experience in a form that may be of use to them.

4. I apologise for going on at such length. I know from my experience of 32 years as a teacher and another 18 as a student and from the many occasions when I have attempted to summarize my experience of BPD, that some readers and listeners tire, lose interest or feel that there is a loss of relevance in the account because of its length. Still others are simply not able to read such a lengthy statement or follow a long verbal explanation. When I post such a statement on the internet such an individual, such a reader, requires that I write in a simple style, write briefly and with simple words. I do not always KISS, Keep It Simple Stupid, as advised in much contemporary business English programs, programs I have myself taught.

5. When some readers are required to read such a statement like this one: (a) in a formal educational setting, (b) as a member of a government department involved in making an assessment of my condition, (c) in any one of a number of other settings where an assessment of my condition requires reading a lengthy piece/essay/statement like this or (d) simply as someone reading in their leisure-time, the exercise proves too onerous, too uninteresting or too tedious for them. I can understand this reaction for, I too, have my limitations and often am disinclined to read long statements on many a topic. Of course, many others appreciate this more longitudinal, retrospective account and I have had a good deal of positive feedback on the internet thanking me for this analytical, although lengthy, narrative.

5.1 This age has become a highly visual one and, I might add, a world with an auditory and sensory emphasis. Reading is only one of many ways people learn and, for many, reading is not their preferred learning mode. Then, too, we all have our constellation of personal interests and I certainly would not expect everyone I meet and who knows me to take any particular interest in this statement any more than I might take an interest in some of their passions and concerns, problems and activities. We cannot all be interested in everything and take part in all of the activities we are encouraged to take part in as part of today’s world, if we ever could in the past in other ages and centuries.

5.2 I felt it was essential to place my illness and my experience of it in context, so to speak. I know there are many, indeed millions, who have problems far worse than my own. But this is my story, my disability story, briefly or not-so-briefly stated. I could say much more and I do so in my autobiography/memoirs for anyone who is interested in reading my story. I would like now to turn to “the road ahead.”

5.3 This account of my BPD experience is, in some ways, my construction of a meaning-making narrative. This narrative construction permeates this work, as does an emphasis on historical and social contextualization and interaction over time. There is a Protean Self which emerges from the confusions and contradictions of life experience. This protean person has developed a multiplicity and malleability of self in a process of what might be called a continuous psychic recreation. This recreation allows for a self of many possibilities. This is consistent with the creation and constant re-creation of a "life-story" or meaningful psychological and historical narrative of self that integrates my several identities.

5.4 Traumatic memory and the events associated with it are experiential, not narrative. This memory takes the form of fragmentary sensory and/or memory re-plays, inexplicable rage, crying, and terror or immobilizing body states. Proteanism has many useful features in helping a person with BPD deal with his ordinary thoughts and actions. Often these thoughts and actions are unconsciously and erroneously assumed to be trivial although holding a wealth of significance. By encompassing multiple forms of interpretation including linguistic, semiotic, and aesthetic; bodily, psychic, and emotional, this protean self provides me with a way to see through the surface, to face the depths of meaning and my roles in its construction. I am able to "listen" to my own "voices" so that I may better hear the voices of "others," to be vulnerable with a cautious, not fearful, stance. Thus, as I read and reread this story, this analysis, several stories, texts, accounts, emerge. Writing this account forces the story into an artificial linearity, in the name of clarity and as a bow to the expectations of readers.

THE ROAD AHEAD: Responses to This 110,000++ Word BPD Story:

1. I look forward to hearing from anyone in the weeks, months and years ahead should my experience be relevant to theirs and should they want to discuss these issues further. My friends, former colleagues and associations, the fellow members of the Baha’i community with whom I share this story from time to time and, indeed, many others who come across this account--for the most part on the internet--will each have their own individual reactions to this statement. This is only natural and to be expected. “Coming out” is a popular sport these days and, in spite of appearances to the contrary, I am not inclined to talk about my personal problems in the context of my day-to-day relationships. For the most part we fight our personal battles alone but sometimes, occasionally, we get with a little help from our friends.

My email address is: ronprice9@gmail.com; my snail-mail address is: 6 Reece Street, George Town, 7253, Tasmania, Australia and my telephone number is: 03-63824790.

2. When I do share some of my story, for sharing too is a more popular activity these days, I find others not inclined to be interested anyway or, if interested, they are not sure what to say and so they change the subject and we never talk about it again; or I change the subject to relieve the embarrassment caused by their not knowing what to say. Sometimes, though not often, an engaging conversation ensues about the disorder. As I say above, I am happy with most reactions that come my way, although some reactions require more thought, patience and comment from me than others. Two reactions still annoy me even after these several decades of BPD experience. One type sees me as having no problem and advises me: (a) not to be troubled by it and/or (b) not to talk about it. A second type of reaction leaves a sense of gap, emptiness or distance between me and the other party. If I give the person a series of basic details and the briefest of history of the illness orally or in writing and I get no response, I feel puzzled that the person is not at least curious to find out or understand more.

3. Most of my ‘coming out’ takes place, as I say, on the internet and in that medium I can take my time for a more considered response to whatever written reaction results from one of my postings. It’s a safer zone, cyberspace, at least safer in some respects. The internet also has its pitfalls, its snares and its difficult people with whom to deal. At some sites I get site administrators, moderators and participants wanting me to participate more than I am prepared to do. I have a life outside talking about BPD and writing about it on sites can be onerous especially if one takes part in some 100 BPD, D and mental health sites. At other sites, some participants find my posts too long and let me know in no uncertain terms. I usually respond in writing to written reactions at sites when readers do write to me and I tend to respond within a few days at most unless, as sometimes happens, I am simply not aware of a response that has been posted. Some people write to me at my email address, but as yet very few. Participants at locations on the internet where I keep up a correspondence, as best I can, at these 100 mental health, bipolar and depression sites prefer the degree of distance provided by the internet over, say, a personal email.

4. I would like to say a few things about ‘coming out’ in relation to employment. If I had admitted my mental health issues at any point in my career when I had to apply for a job and fill in a form it would have been a problem. Filling in a form that required ticking a box for ‘do you suffer from any mental illness?’ would have resulted in the employer declining to hire me. Occasionally I was honest and on two occasions I was immediately refused a job that had been virtually promised to me. The last time this happened was in 1980 and I determined, after that date, to fill boxes in—in my favour—and I did this to the end of my employment life. Not everything that a man knows need be disclosed or, to put the case most harshly, one has to lie.

4.1 When I give this statement on rare occasions to friends, Baha’i institutions and others whom I think may benefit from what has become quite a long read of 90,000 words, there are a range of reactions not unlike those I have already indicated above, but which I summarize here as: (a) no comment, (b) a feeling sorry for me and telling me so, (c) a set of questions in writing or in person, (d) giving me advice, (e) an honorific comment; for example, a reference to the quality of my writing, the comprehensiveness of the account or its academic tone and content; and/or (e) some combination of these five reactions. I am generally not troubled by people’s reactions after all these years, although I often have been in the past.

4.2 On rare occasions someone wants to strongly advise or assert a point of view; sometimes that point of view is at variance with my own. They might suggest, for example, that I try: (1) various remedies like: special foods and diets, medicinal and herbal solutions such as drinking lots of carrot juice(1960s), (2) praying and meditating more(1970s), (3) using positive thinking or some new age system of thought and thinking(1980s), (4) not talking about the disorder, assuming a position that I’m really okay and just to get on with my life(1990s) and (5) some treatment like cognitive-behavioural therapy, insight-oriented counselling and care or some other form of therapy that does not use medications but draws, for example, on the field of neuroplasticity, the retraining one’s brain by creating new thought patterns and trying not to reinforce the thoughts we want to erase by not thinking them or by not going down that pathway(2000s and 2010s).

4.3 Evidence in the last decade demonstrates that neuroplasticity, a fundamental mechanism of neuronal adaptation, is disrupted in mood disorders and in animal models of stress. Chronic stress, which can precipitate or exacerbate depression, disrupts the capacity for neuroplasticity, while antidepressant treatment produces opposing effects and can enhance the capacity for neuroplasticity. But, as I say, CBT and the virtues of neuroplasticity are, for me, simply interesting areas of knowledge but not treatment venues I seriously entertain now in my late adulthood happily routinized as I am on my medications.

4.4 I could comment on each of these suggestions in some detail here since they each have their merit and relevance but, for several reasons, I am not prepared to take any of them seriously now, after all these years and being happy with my present treatment program. However relevant some of these suggestions are, and however frequently I receive these suggestions, they each have serious downsides. Positive thinking and various what you might call ‘mental technique’ approaches do not translate easily into effective treatment for BPD. BPD is unaffected by attitude and, even if BPD was/is affected by attitude, I do not want to take the reprogramming steps required for improving my coping mechanisms. Neuroplasticity promises much and, even if the promises are valid, the effort to implement them is simply more than I can find and apply with my will-power and energy levels. For many others, though, I encourage their investigation of neuroplasticity. Neuroplasticity, also known as brain plasticity, is an umbrella term that encompasses both synaptic plasticity and non-synaptic plasticity. It refers to changes in neural pathways and synapses due to changes in behavior, environment, neural processes, thinking, and emotions, as well as to changes resulting from bodily injury. The concept of neuroplasticity has replaced the formerly-held position that the brain is a physiologically static organ, and explores how, and in which ways, the brain changes in the course of a lifetime.

Neuroplasticity occurs on a variety of levels, ranging from cellular changes (due to learning) to large-scale changes involved in cortical remapping in response to injury. The role of neuroplasticity is widely recognized[by whom?] in healthy development, learning, memory, and recovery from brain damage. During most of the 20th century, neuroscientists maintained a scientific consensus that brain structure was relatively immutable after a critical period during early childhood. This belief has been challenged by findings revealing that many aspects of the brain remain plastic even into adulthood.

4.5 A peer environment dominated by a focus on attitude as a key to the survival of BPD clients/patients often has the result of isolating a person like myself who is seen by some as a pessimist. Such an attitude is sometimes seen by the sufferer, like myself, as offensive, insensitive and/or ignorant. Of course others, who have a different attitude to my BPD, see me as a stoic or a realist, a pragmatist or simply an experienced person who has learned the ropes and is capable of making his own decisions. The interpersonal environment, the attitude of others, I must emphasize though is a crucial one for the BPD sufferer. I have not always maintained my emotional cool, so to speak with these suggestions from others. In this respect, though, I am improving in my patience and my self-restraint, partly because of: (i) the new medication package I have begun in the last two years and (ii) an awareness on my part that there are other treatment programs of relevance.

4.6 We all have to deal with the reactions of others, of course, and these reactions are not always to our liking. Being calm, however much desired, is not always achievable or even desirable for most of us. I must add, though, that this new medication package is certainly conducive to a more calm demeanour for most of the time. As I often say, in trying to summarize the context for the new tranquillity on this new medication regime: “it is harder for my wife to get a rise out of me than she used to.” In the wider social domain, when faced with what would formerly have caused my punitive rebuttals/reactions to some of the statements of others, I exhibit much more patience and self-control. In the day-to-day round in my private domestic life with my wife, my wife’s verbal stirrings, criticisms and general verbal output which formerly would have stressed my sensory equipment does not do so. My demeanour remains calm and relaxed virtually all the time in our daily life together.

4.6.1 This calm and easy-going demeanour, though, is not true on all occasions. My wife could give readers a different view of my interpersonal skills in the several years on the NAVAL/effexor medication package, and the three years on seroquel and effexor. My view of my interpersonal skills might be quite different from those of my son, my step-daughters, my step-grandchildren, and some of my friends among others. We are each chameleons in our own ways. My life on medications is but one example.

4.7 My wife would say, and I would agree with her, that after two hours in social settings my calm exterior is often lost and I am no longer the genial host when she and I or just I am in a social setting. She might go on to say that giving way to my erotic urges and my irregular inclinations, my passions and obsessive-compulsive desires, as well as to provocations and pressures is also, paradoxically, a pattern that is more apparent in these last 4 years on the new meds(5/07-1/11). These two tendencies, then, calmness and an easy-going nature on the one hand and a giving way to inclinations and pressures in interpersonal interaction on the other, exist side-by-side and in greater intensity on this medication package.

4.7.1 I would like to make some extended and more detailed remarks about my incapacity to deal effectively with social interaction for more than about two hours especially on my meds in the 4 years(5/07-1/11), as well as from 2/11 to 3/13. I made the initial remarks on this subject in section 9.2.4 above. My medications, my creativity, my BPD and my OCPD all combine in a fine and somewhat convenient way to support the lifestyle my body and my mind desire, as well as the artistic, vocational and avocational purposes that I also desire. All these factors come together to provide me with a basis for my retreat from the world to find the kind of solitude in which to: (a) pursue the new avocational focus on writing that I have developed in these years of my late middle age(55-60) and late adulthood(60-71) and (b) invent, so to speak, the self I desire and need to do my new work, to focus sharply on the literary task that has come to take the central pivot of my life. While this so-called ‘invention’ is partly true there are a host of factors that militate against my social engagement beyond a very limited extent. I deal with this in my memoirs and do not want to expatiate on this subject here.

4.8 Who knows what lies ahead in my dealing with BPD? At the age of 71 I would like to put this story permanently to bed--forever, never to return to another, yet another, chapter in the long tale, this sequence of events with a long duration or longue duree, to use a French expression in terms of my own life rather than the life of a civilization to which that term is usually applied. But I have my suspicions that the story is far from over. I am able to work at reading and writing for at least 8 hours in total most days in a series of small time periods even after all these decades of BPD. I am still a functioning member of society, but only in certain quite defined and limited ways.

4.9 This new pattern is, to some extent, just a repeat of the old, but there are new additions to the old pattern and I have tried to summarize the package of behaviour here. This pattern has become apparent after 4 years on this new medication package(5/07 to 1/11). This pattern contains the following details, details which have altered, of course, as this medication package itself changed in those last 45 months:

(a) alternating periods of fatigue and sleepiness on the one hand; and energy and enthusiasm on the other, often within a few minutes making any sustained work/activity beyond one to two hours difficult to maintain;

(b) a sleeping pattern as follows:

A. (from 5/07 to 12/08): (i) staying awake to 1 to 3 a.m., (ii) sleeping for two hours and (iii) then getting up to urinate and returning to bed; then (iv) sleeping until, say, 5 or 6 a.m. or 9 or 10 a.m. and, finally, (v) sleeping for an hour or two in the day/evening. All of this takes place within a context, as I pointed out above, of short bursts of: (I) reading and writing each day adding up to an 8 hour total of literary work per 24 hour period—and (II) short bursts of other activities(domestic, social and, personal) adding up to another 8 hours; and a sleeping pattern:

B. (from 25/12/08 to 5/11): (i) staying awake until 1 to 2 a.m., (ii) staying in bed until 9 to 10 a.m. and (iii) sleeping for 1 to 2 hours during the day and/or evening making a total daily average of 8 hours of sleep/day and some 10 hours in bed.

(c) a certain excessiveness/speed in speech patterns and a tendency to dominate/speed verbally in social settings, a lack of moderation, a lack of control as well as an overly, overtly emotional state and over-the-topness, so to speak, which is more problematic when I am, as I say, in those social situations, especially social situations of more than two hours of interaction;

(d) a speeding in situations that do not require speeding like: washing dishes, making a cup of coffee as well as other domestic and daily activities just in normal everyday settings and especially after 3 or 4 hours of social interaction;

(e) quick alterations in energy levels, for example, hyperactivity to completely fatigued, and with that sudden fatigue and need for sleep;

(f) OCD, obsessive-compulsive behaviour: straightening & squaring bits of paper, magazines & newspapers on tables and desks and other forms of tidiness much more than in previous years. My psychiatrist does not see this as a serious problem on the spectrum of OCD behaviour;

(g) urination and defecation may be a side-effect of taking effexor. Other side effects which may be due to taking effexor and which I exhibit include: vertigo, impulsive behaviour, insomnia, dizziness, vivid/abnormal dreams, apathy and fatigue; side effects from taking NAVAL include: sedation, nausea and dizziness which I experience occasionally. Beginning in September 2009 I had what is known as benign vertigo and I got rid of it after 2 months with standardized exercises. This may not be due to the meds;

(h) defecating with a slight degree of diarrhoea on average once every 4 to 5 hours during the 16 hours I am awake which, with the frequent urination and the off-and-on sleepiness/fatigue has a soporific effect on my general energy levels. It feels as if I am either eliminating waste or getting sleepy/about to feel fatigued just about all the time. I don’t feel debilitated by this combination of bodily activities, just depleted of any sustained output of energy and, hence, not capable of any sustained physical or social activity; I have become content and comfortable with what might be called a social mediocrity. If I was still a classroom teacher I would not be able to cope with the necessary social theatricality, incivility and control issues, as well as the emotional demand. Back in the 1980s I felt the lithium I was taking was limiting my social and creative capacity and it took me a decade to come to a full acceptance of my medication because I felt it was preventing me from being ‘the real me.’ But I do not have this problem of acceptance now; indeed, I have not had a problem of acceptance from 1990 to 2012;

(i) a nightly dream pattern that is more vivid/abnormal/extensive than ever before in my life leaving me with a dense-and-heavy, somewhat disoriented, feeling on waking; I began taking a panadol pill on going to bed at night to help me feel calm and sleepy and ready to go to bed;

(j) perhaps the most important feeling on the negative scale is an emotional and psychological weariness as outlined in section (i) above as well as a tedium vitae, a Latin expression for a weariness of life, from the long years and many scars left from battling this BPD. But this feeling is only after midnight and after 8 hours of intellectual labours;

(k) Now that I am back on the effexor(26/1/09 to 16/8/15), and have added the seroquel this tedium vitae, once very pronounced especially after midnight and an 8 hour day of reading, writing, research, editing and publishing, has been cut back to a bare minimum--at least as I write this 2nd draft of the 15th edition of this account on 18/8/'15. In May 2015 I reduced my effexor to 62 and 1/2 mgs/day but, after 10 days on this new regime, I went back on the 75 mg because of high tension and discomfort in the evening.

5. After I completed the above statement in section 10.3.9 I thought that these dozen symptoms taken in total were a little ‘over-the-top,’ as they say in Australia. The list, though, is accurate. The statement seems a little over-the-top because I am not used to placing all of the symptoms in one place on one page. Some of the above traits, patterns or symptoms, of course, are problems everyone has in different degrees. These symptoms are: (1) the present constellation of behaviours or negative features of my BPD and (2) a cause of concern in some ways more to my wife who has to live with me than they are to me. Being the battler that she is, and my personal carer in more ways than one, she grumbles and grouses more than usual as a result of my eccentricities and/or more often as a result of hers. This is one of the worse side-effects of my behaviour, its effect on my wife but, over time, she has come to understand my behaviour more and more and, with that understanding has come greater acceptance of my behaviours, especially my asocial tendencies.

6. This tedium vitae, fatigue with life, on the one hand and my negative, strained and over-the-top behaviours after two hours of social interaction on the other are the major bases, raisons d’etre, of my asocial tendency. My residual death wish remains when my head hits the pillow each night and this contributes, I have little doubt, to this same asocial tendency. There is, though, accompanying this weariness, an alternating or coextensive quiet tranquility, a tranquility very useful for the act of writing. This tedium vitae and its accompanying death wish are most pronounced, indeed, they only exist together just before going to bed. I should also add that my writing life, my creativity, is strongly linked to my need for, and taking pleasure in, solitude. I cannot divorce my asocial inclinations from my desire to write, from my creative activity.

I can be, if I so desire, an inconspicuous fellow who would never stand out in a crowd. I am well practiced and can play the game of life in social interaction for short periods of time. After 1 to 2 hours, though, I tire of the verbal ping-pong required. If I did not have a wife, I would eat alone, live alone, spend holidays alone. I learned in my early childhood to play by myself. Still, despite my reclusive habits, inflexible online routines, and a sliver of social awkwardness, I am, as I move through my seventies, remarkably content, even blissful. Unlike, Mark Foster whom I thank for some of these words, I do not see myself as a person who wears a mask. I can and I do enjoy modicums of social interaction. This is a recent development and it seems associated with my new medications and my new lifestyle as a writer, after decades of a highly gregarious lifestyle.

As a tenured full professor of sociology at a Kansas City area college, born and raised in the City of New York and its suburbs on Long Island, Mark Foster has enjoyed a string of academic accomplishments. He has Autism and many of his gains were realized despite his Autism. One of the more salient motifs within his biography may be characterized as a recurrent failure at conforming to expectations. In his professional life, for instance, it took him roughly 25 years, in the end through an instructional consultant, to enhance his effectiveness at relating to students. I did not have these problems which Foster had to deal with as a result of his autism. My problems were associated with BPD.

I have come to slowly learn, as Foster did, that an acquiescence to one's distinctiveness should not be mistaken for a preoccupation with one's limitations. Foster refers to a 14 year-old adult in Robert Heinlein's popular science fiction novel, Stranger in a Strange Land who made the remark that: "I would likely identify most strongly with a human reared by Martians." From Foster's early childhood years, his life experience had staunchly situated him as the self-conscious performer, the outsider, looking in while crafting a repertoire of multiple impersonations through his upstairs bathroom mirror. This, of course, was part of his autism. My adaptive behaviour has had to do with BPD.

6.1 I should mention, somewhat parenthetically, that I have had an increase in weight in the last 35 years(1980 to 2014), some 80 lbs. since beginning my lithium, anti-manic, mood-stabilizer, treatment in 1980. This weight gain may be due to my medications since a side effect of both lithium and effexor is sometimes weight gain. I have a body-mass index (BMI) of 31.5. A BMI of 27.5 and above results, some studies show, in a high risk of heart disease and other health problems. This is not always the case though; for example, one study showed that there was an unexpected better survival in overweight/mild obese patients. I am mildly obese.

6.2 My GP says that my excess gas may be due to my overweight(230 lbs on a 6 ft(183 cms) frame results in a BMI—at the lowest edge of obese, that is mildly obese at 31.5 using a standardized BMI(body-mass index chart). The change in the position of my stomach when I get up may be the main cause of my gas as well as a simple lack of self-control. The expulsion of gas is due to swallowing large amounts of air and gulping food or drink too rapidly, to anxiety and to drinking carbonated beverages. I am not aware that I am swallowing air, although I do eat and drink too fast and have done so all my life. Excessive air in the stomach is not the only cause of gas. For some people, and I may be one, the expulsion of gas becomes a habit and does not reflect the amount of air in their stomachs. This may be the case with me. During the three years on this new meds package I have more gas than ever before in my life. Perhaps this is due, as I say, to a lack of self-control, an “I can’t be bothered” attitude, fatigue and lethargy. I also have a mild degree of flatulence. While all of this may have no relationship with BPD, this elimination of gas does provide a backdrop to everyday life, may be due to my medications and may have some tangential effect on my mood. It certainly affects my wife since she is a more refined person than I am and she finds all of this a gross habit, even if she gets used to it. I could have left this subject to Appendix #4 and dealt with it under “other illnesses, problems and health problems in my life since 1999.”

7. The significant others in one’s life are an important source of relevant feedback and since I have been on the medication—and its several stages from 5/07 to 4/12--and the new meds from 4/12 to the present---my wife has informed me on many occasions of: (a) an increase in OCD behaviour, (b) an increase in speeding and an intensity of various types of what she calls frenetic activity or, more colloquially, fossicking-about, (c) an eccentricity, an over-the-topness or an inappropriateness of verbal responses in social situations and (d) heightened brain activity or hypomania, a sense of speeding-in-my-brain resulting in the feeling of a need for sleep.

7.1 For the above reasons and due to my wife’s sensitising me to my abnormalities and eccentricities, I summarise those symptoms here. I will return to the theme of: (a) relevant feedback from significant others in my life and (b) a discussion of the above symptoms in the years ahead, if necessary/useful. In the process I hope to provide more of this ongoing story, a description of my future and the most recent physical, mental and emotional states as I experience these symptoms on the medication regime, a regime I began in the first week of April 2007, settled into with both medications in mid-May 2007 and with the level of effexor from 26/1/’09 to 15/5/’11(i.e. 28 months).

7.2 For the above reasons it is my view that holding down a full or part-time job would be unwise, although this is no longer an issue on two old-age pensions as I am. My psychiatrist supports me in this view as does my GP each of whom are happy to provide testimonials in support of my decision not to: (a) apply for jobs anymore and (b) serve on any volunteer bodies requiring extensive/long periods of social interaction. They were happy to support this position, my view of employment, when I was on the Disability Services Pension which did not require me to work. This has been the case since May 2001 when I was 57. I have been on two old age pensions for 4 years(7/09-10/13). This life-status-situation, as I say, does not require me to engage in employment. I should reiterate, though, that my psychiatrist does not regard the symptoms (c) to (i) in section 10.3.8 above as problems of a serious or even minor nature, insofar as the excesses of my BPD are concerned.

7.3 During the ten years 2005 to 2014 I: (a) brought the little volunteer activity I was still engaged in to an end, and (b) limited my taking-on any new work as much as possible due to the presence of the range of symptoms I have outlined above. Social and community responsibilities, situations and activities that go for too many hours, as I indicated above, are emotionally exhausting. I had no desire to take part in them and eliminated them from my life as far as this was possible. I always avoided, if at all possible, what would once have been my community and social commitments. Being on the AOAP and the COAP, as I indicated above, makes the issue/the necessity of employment FT, PT or casual work non-existent from the standpoint of Centrelink and employment bodies. Volunteer groups, like the Bahá'í communities, various fund-raising groups and local organizations in the town in which I live, still seek my assistance. But I rarely say ‘yes.’ Saying “no” is sometimes a difficult task especially when: (a) expectations are placed on me by group/family members and (b) explanations are both difficult to give and difficult to be understood by those to whom they are given. I have already discussed this subject above and no more comment is required here.

7.4 I will describe below some of the details of my medications in the last three years largely for my own interest and memory since, unless I write these details down, I cannot remember them. I have now been on variations of this new medication package for nearly 5 years, 5/07 to 4/12. The last two half-hour consultations with my old psychiatrist were on 13/11/07 and 13/11/’08 and the results of these consultations are outlined below in Appendix #1. The stages in the reduction of my anti-depressant, effexor, levels were advised by my psychiatrist and I have described them above and below as those changes continued.

7.5 The other symptoms I outlined at the last visits to my psychiatrist were not considered problems to deal with insofar as medication alterations were concerned. Three weeks after my 30/11/07 consultation, I decided to reduce the effexor levels from 150 mgr. to 112 and ½ mgr. I remained on this reduced effexor level for five months, that is from 24/12/07 to 12/5/08. Since: (a) I was still sleepy/ing too much of the time and (b) I felt the need to regularize/routinize my nighttime sleeping patterns, on 12 May 2008--I reduced the effexor level to 75 mg. per day. I have reported the results of this medication change as alterations in my behaviour patterns and life-routines became apparent. After seven months(12/5/08 to 13/11/08), though, I was: (a) getting five to eight hours of sleep per 24 hour period and (b) my wife saw my demeanour as “clearer—in my eyes,” as she put it, by which she meant there was greater clarity and less sleepiness in my physical/facial expression.

7.5.1 I have appended to this statement the notes from the last two consultations, 30/11/’07 and the 13/11/’08, with my psychiatrist in appendix #1. They may be useful for others who read this statement and ponder on the relevance of note keeping in general in relation to their disorder and in relation to visits to doctors in particular. These notes can be found in Appendix A.

7.5.2 In November 2008, as discussed in the 13/11/’08 consultation with my psychiatrist, I reduced my effexor level to 37 and ½ mg. and on 10 December went right off the effexor. I had originally gone on the anti-depressant, luvox, in 2001 to reduce the nighttime blacknesses and I decided that if they returned I would increase the effexor level to 75 mg./day. After six weeks on no effexor(10/12/08-24/1/’09), the dark side of BPD returned. The above symptoms have continued, although I: (a) am sleeping more soundly with a solid 8 hour per day average, (b) am disinclined to get up once I have gone to bed and (c) have a heavier feeling in my head once I wake up which dissipates if I lay in bed half asleep for an hour or more on waking. As I noted above, though, on 25/1/09 I went back on 37 & ½ mg. of effexor daily for the reasons outlined above and after one year, to 1/10, my intention was to stay on this present regimen for as far as the eye can see.

7.5.3 Altering the brain and its chemistry through medication, alters so many things about one’s life. One becomes a different person since the brain is the central data processing unit in the body and this processing takes places differently due to different chemistry in the brain. It goes without saying that this alteration in brain chemistry and, therefore, behaviour is also true as a result of drinking alcohol, taking mood enhancing drugs or ingesting one or more of many a chemical/pharmaceutical on the market today. Effexor, to choose one example from the many medications I have taken since the mid-1960s, belongs to a group of antidepressant drugs called “selective serotonin reuptake inhibitors(SSRIs)” and their very name is a good example of the terminological difficulties involved for those who persist in trying to understand BPD. This ongoing story has been, is and will be partly about that different person I have and will become as a result of my BPD and the medication changes. I hope the above account is as much use to others as it has been to me in writing it over these 15 editions with, perhaps, as many as five drafts for each edition, in the last 15 years. Much of the personal use, though, is: (a) to help overcome the deficiencies of memory, (b) to provide a base for changes I might want to make and (c) to give me a sense of security that comes from writing things down.

7.6 It will be necessary, of course, to make alterations to the above document in the months and years ahead to: (a) include new information and new perspectives on my past experience, (b) add to the document as changes to my life occur that are related to my BPD, (c) maintain as comprehensive and succinct a story as possible; and, finally (d) to bring those to whom I write this account up-to-date on this story. Research shows that anti-depressants can cause the cycling of the bipolar condition to increase even in the presence of mood stabilizers(“Mariette Hartley triumphs over bipolar disorder,” 8/1/2003 in USATODAY.com).

7.6.1 I would not characterize my behaviour on these new meds in the last 5 years, and especially the last 18 months, as ‘rapid-cycling,’ Rapid cycling is a term applied to BPD patients who have had at least four episodes of mood disturbance in the previous year. Most people have a broad range of positive to negative behaviour but rapid cycling has a severity of mood shifts and two is the greatest number of shifts I have had in any one year: 1963, 1964, 1978, and 1980.

7.6.2 There are now 100s of people at more than 100 BPD, D, mental health, general health and other internet sites for whom and to whom I write this account or part of it. Most of the correspondence that has ensued from this posting takes place, as I said above, at the internet sites. There are, as well, a very small handful of personal friends and relations to whom I have sent this story for a range of personal purposes. Some in this latter group want to know this story. I feel it necessary, for various reasons, to inform others so that they have a better understanding of my present situation and past condition. But whatever the reason for my utilising/writing this account, its contents have become of value to many others who suffer from this disorder, similar disorders or, indeed, have other problems of the human condition that possess a traumatic or quasi-traumatic quality, particularly in the areas of depression and men’s issues which have become more topical and discussed more frequently in recent years.

7.6.3 Given the complexity, subtlety and difficulty in comprehending BPD and its many manifestations, written descriptions of this disorder and/or people’s experience of it do not necessarily and/or immediately produce any significant degree of understanding on the part of others. In addition, the very length of this written account, to reiterate an important point in the communication process, puts many off. This is due to a host of reasons associated with people’s disinclination to read long passages on the internet, a medium which for many is used to focus on short and pithy messages and quips, what one might call a kind of “internet-speak.” Even long passages anywhere else for that matter can be too onerous for many people, thus making the transmission of content like that contained herein difficult for the communicator, namely me.

Even my own personal understanding of the labyrinth, the twists and turns, of BPD keeps me busy. Understanding does not come easily here for the lay person. And I am a lay person. My story, like so many stories in life, is a work in progress. I look forward to receiving feedback from anyone who feels moved to write words either of encomium or opprobrium, praise or criticism, to make suggestions and/or to outline their reactions to this long essay/report.

As I have indicated above in this statement, this 15th edition, I have included a record of information that I keep as a result of visits to my GP. This BPD does not exist in a vacuum and, for some readers of this account, this largely peripheral information may be of value. I have included this record of issues raised with my GP here, as I say, in Appendix 4. My epic 2600 page memoir or autobiography is also relevant for keen readers as a base for the context of this BPD, a context that is my life. Readers wanting to examine this life-narrative can go to: (a) eBookMall, (b) Baha’i Library Online or even (c) google the phrase Pioneering Over Four Epochs for great slabs of my story. And, finally, I have included a personal email and comment in Appendix 6 from Garret LoPorto, author of The DaVinci Method, to provide a personal context from one of the popular authorities in the field of the study of BPD.

8. On 16 and 23 April 2012, as well as on 9 May and 10 August 2012, and again on 29/1/'14 I had consultations with a new psychiatrist, a Dr. George Hyde, in Launceston. I began a new program of pharmacology, pharmacotherapy, or drug therapy. I had a one hour, a 20 minute, a 40 minute, and finally two 30 minute consultation, respectively, on these five occasions. At the end of the 4th consultation we decided that: (i) I would not call to make another apppointment unless some problem occurred, or unless I was in need of more advice, (ii) I was happy with my progress on the new meds, and (iii) I would now be in the hands of my GP in George Town to discuss any immediate problems that arose. I wrote a four page report to put my GP in the picture, and Dr. Hyde sent an email to my GP for her files informing her of my current status. After 14 months on this new medication cocktail, I talk to my GP briefly once or twice a year in relation to my BPD. Most of my discussion with my GP, and other doctors, are about other matters since I am generally happy with my new meds regime.

8.1 I discussed my OCD and decided that it was my responsibility not to annoy my wife with my OCD habits. The key here in relation to my relationship with my wife was to exercise more restraint when it was clear that I was bothering her with my OCD habits. My wife and I had decided over the first 4 months of 2012, before seeing this new psychiatrist, that it would be a better life-style pattern if I did not sleep during the day, and if I had more energy to exercise and do physical work around the house. In the process it would be hoped that I might reduce my cholesterol levels and weight, as well as be more gregarious. I have gained 80 lbs since 1980 on meds for BPD, an increase of 50% from the 160 pounds I weighed in 1980. My wife wanted to have my old social self back, the self I was like back in the years I was on lithium(1980-2001), and in my early middle age(1984-1994) as well as my young adult stage(1964-1984) in the lifespan. After 14 months on this new package of meds, I can say she has some of the old-me back, but it does not appear that I will ever be as gregarious or as energetic on these new medications.

8.2 On the last meds package from 4/'07 to 4/'12, I did not have the enthusiasm to exercise sufficiently to get my weight off. It was my wife's hope that I would also, as I say above, be more gregarious and be capable of enjoying more than 2 hours of social activity at a time without losing my edge, my self-control, without speeding, as I had done in the last five years on my NAVAL and effexor meds package. Dr Hyde was a psychiatrist whom my wife regarded as more modern and inclined to use the latest medications and approaches to my BPD. He might even help me initiate some CBT therapy if I wanted to go down that route---such was the view of my wife, the most important person in my life-narrative both now and in the previous four decades since we began our relationship.

8.3 I decided by the end of my third visit with Dr Hyde that, for the present time, I would not engage in any form of talk therapy:CBT or otherwise. I had been with my previous psychiatrist for a dozen years, 2001-2012. This new chap was 40ish and not 70ish like my previous psychiatrist. He was a colleague of my old psychiatrist, and both my wife and I were more than satisfied with his service after these visits. I told Dr Hyde that I was coming to him due to my wife's insistence that I try a new psychiatrist, and I asked him to convey my best wishes to my old psychiatrist.

8.4 As a result of these 5 consultations I became stabilized on a seroquel-effexor package. Seroquel is an atypical antipsychotic. These came into use in the 1990s and were approved for the treatment of BPD by the FDA in the USA. It is one of the neuroleptics which is just another word for an anti-psychotic, a tranquilizing psychiatric, medication primarily used to manage psychosis for BPD sufferers. Typical antipsychotics, sometimes referred to as first generation antipsychotics, conventional antipsychotics, classical neuroleptics, and traditional antipsychotics, or major tranquilizers, are a class of antipsychotic drugs 1st developed in the '50s used to treat psychosis.

Typical antipsychotics may also be used for the treatment of acute mania, agitation, & other conditions. The first typical antipsychotics to enter clinical use were the phenothiazines. Second-generation antipsychotics are known as atypical antipsychotics. Most of the drugs in the second generation, known as atypical antipsychotics, have been developed more recently, although the first atypical antipsychotic, clozapine, was discovered in the 1950s and introduced clinically in the 1970s. I write this information, and outline these terms, largely for my own use, but also for others at the many mental health internet sites to which I belong. Dealing with BPD requires, at least for me, as much familiarity with the medical, the psychiatric, language and its medications as possible.

8.4.1 Both generations of medication tend to block receptors in the brain's dopamine pathways. Antipsychotic drugs encompass a wide range of receptor targets. The atypicals are less likely to cause abnormal body movements, or motor-control disabilities in patients. They are now deployed as: antidepressants, anti-anxiety drugs, mood stabilizers, cognitive enhancers, anti-aggressive, anti-impulsive, anti-suicidal and hypnotic or sleep medications. Seroquel began to be used to treat BPD in 2004 as a tranquilizing psychiatric medication primarily to manage psychosis and depression but, as I say, it is now used for the other purposes especially PTSD.

8.4.2 Seroquel has come to be increasingly used in the management of non-psychotic disorders and as an add-on with medications like effexor to treat: depression, episodes associated with bipolar I disorder(my disorder), and schizophrenia. It is also used as an adjunct therapy to and maintenance treatment with NAVAL. I went off NAVAL after only 7 days on this new medication, seroquel, in April 2012. Seroquel is also used to treat conditions such as: OCD, PTSD, borderline personality disorder, and Tourette/'s syndrome. It is my view that I have some symptoms of all of these disorders, as I point out elsewhere in this lengthy account of my experience of BPD.

8.4.3 Since seroquel has also been used by physicians as a sedative for those with sleep and/or anxiety disorders to calm people down, it turned out to be the perfect medication to accompany both sodium valproate(NAVAL) and effexor as was my case by 23 April 2012. After the 2nd appointment with the latest, my newest, psychiatrist, Dr Hyde, I went off the NAVAL. I kept 500 mgs of NAVAL for the first week, and on 23/4/'12 I went right-off the NAVAL. By my 3rd appointment in early May 2012 I was on 100 mgs of seroquel, but I reduced it to 75 mgs later in May because I was too sleepy. As I write these latest words on 16 August 2015, I have been on 50 mg seroquel(immediate release) for 2 years and 5 months(3/13 to 8/15).

I took 50 mgs of seroquel for the first week, 100 mgs starting on 23/4/'12 and 75 by 23/5/'12. I took a 50 mg and a 25 mg tablet between 6 pm and 8 pm for ten months. From March 2013 to March 2014 I took the seroquel at various times from 8 pm to 11 pm. By the time I was up and had my morning medication it was usually between 9 and 11 a.m.; seroquel is at its lowest level of effect by that time in the morning, thus ensuring that I have energy for the day ahead. By noon I have been out of bed for 1 to 3 hours at the most. I took a 75 mg effexor tablet on waking, between 9 and 11 a.m. approx, and in May 2015, as I say above, I reduced the 75 to 62.5 mg. I also began to take acidopholus in May 2015. I take 50 mg. serquel(100 mg split-in-half) now at 9:30 pm. Again, I keep this information largely for myself to help me remember when changes have taken place in my meds. This is all part of my personal longitudinal study and information base, my diaristic, memoiristic, approach to record keeping.

8.5 The general effects of this new medication package have included: (a) a slower movement, & a very relaxed, slightly euphoric, state, (b)less anxiety and sleepiness during the day, as well as more calmness. I went to bed usually between 7:30 and 8:30 p.m. for the first 10 months, as I say above, and I got up for those first 10 months earlier, usually between 7 a.m. and 8 a.m. at the latest. In the first two days when I was also taking NAVAL I felt, what you might say, "out-of-it" in my daily activity. I only had enough energy to walk about slowly and go about my domestic activity slowly: eat, wash dishes, read and send emails, watch TV and chat with my wife, inter alia. By day 3, though,I had more energy. I still had that slightly euphoric and relaxed state. I mention these things because the transition from one medication package to another is often complex and fraught with problems.

The most common side-effect of seroquel or quetiapine, as it is also called, is somnolence and a calming effect. This does not surprise me now after more than 3 years on this new anti-psychotic drug. I am still in bed for 11 to 12 hours a day and I sleep for at least 8 to 9 hours. In addition my energy levels are higher than on the previous medication package that I had been on for 5 years. I don't exercise much more on this new meds than on the old, and my gregariousness has not increased significantly. I mention this because my life-style for 50 years, circa 1955 to 2005, was highly gregarious and energetic. In the last 5 to 8 years I have had to settle for a more solitary, far less gregarious, life-style.

8.5.1 Other common side-effects listed in the description of this medication and which I can see occurring due to my being on it now for nearly 40 months include: sluggishness, fatigue, weakness, dry mouth, and less libido. After beginning to take the medication for my prostate two years and four months ago in February 2013, my libido was reduced even more. I am pleased with this decrease in libido because I tend to be more relaxed and less turned-on sexually. This pleases both me and my wife. Dr Hyde suggested I begin on seroquel at 100 mgs and adjust it to 75 mgs if I am too sleepy: and this I did as I point out above. Any lower a dose of seroquel and there is little effect on my mood, behaviour and sleeping pattern, so I was informed more than two years ago; now, though, I am on 50 mg and there is definitely a somnambulent effect. It knocks me out after 60 to 180 minutes. In February 2014 I began to consider lowering the dose to 25 mg, but I will consult Dr Hyde before doing so. I'll report on any changes and on these side-effects in the days ahead as this new meds package continues. As I write this latest update on 16 August 2015 I feel the need for 50 mgs because I am not confident of controlling myself, that is my anger or my tears, on 25 mgs. I am too likely to get angry and/or tearful on 25 mgs!

8.5.2 I am much less frenetic and do far less speeding on this new meds pkg. After varying amounts of social interaction, and especially interaction with "difficult" people, though: (a) I have a strong tendency to speed and to get very tired, (b) I experience anxiety with a tendency to "go over the top", lose my self-control with anger or tears or both, and (c) I get sleepy and need to close my eyes in company after 1 to 2 hours. If I monitor this tendency, that is, if I simply eliminate social interaction after a certain length of time---as I did on my previous meds package---I have no problems. Anger still occurs and this frightens my wife; so, too, do tears which embarrass her, but anger and tearful episodes are rare. In the last dozen or so years, 2001-2015, with new meds packages, I have rarely got angry, but it is still something I have to monitor. In the first 3 years on this new meds package I have got seriously angry three times, once in the first 6 months, once in the second and once in the last six months; the last episode of anger was moderate, but this concerned my wife. My wife's ill-health, her auto-immune disorder and fibromyalgia makes her less patient and this exacerbates the problems that arise from my anger.

8.5.3 It concerns my wife when my interaction is not appropriate: (i) anger, (ii) tears, (iii) saying things that are not appropriate and (iv) doing things that are not appropriate especially in social settings. This was one reason for this meds shift back in April 2012. A second major concern of my wife is, as I say above, my OCD which has been high since going on NAVAL more than 5 years ago, and my OCD has remained high on this new meds package--from my wife's perspective. When left alone or just dealing with everyday activity with my wife around the house, I don't speed or experience any anxiety. My wife tells me that I thrash in bed far less. She also says that my facial expressions are more relaxed as is the sound of my voice and general demeanor even in social situations with others.

8.5.3.1 Dr Hyde says I am a classic BPDI since I have had at least 1 full manic episode in my life and I have high highs and low lows. BPDII people never have a full manic episode, just hypomania as well as highs and/or lows. I am also defecating 2 to 3 times a day on average and not 4 or 5 as was the case on my previous meds. My feces are not as loose as they were on NAVAL. I will visit Dr Hyde again at a date when I feel it useful to continue our consultations---which may be a year or two from now or even longer---time will tell as circumstances change. In the last two years consultations with my GP have been sufficient without the need to visit my psychiatrist.

9. SOCIAL ANXIETY DISORDER

Social anxiety(SA) is a discomfort or a fear when a person is in a social interaction that involves a concern of being judged or evaluated by others. Until the last decade, since going off lithium in 2007, I had no serious or unusual social anxiety(SA). SA is typically characterised by an intense fear of what others are thinking about them (specifically fear of embarrassment or humiliation, criticism, or rejection), which results in the individual feeling insecure and not good enough for other people, and/or the assumption that peers will automatically reject them. Developmental social anxiety occurs early in childhood as a normal part of the development of social functioning and is a stage that most children grow out of, but it may persist or resurface and grow into chronic social anxiety during their teenage years or possibly in adulthood. People vary in how often they experience social anxiety, and in which kinds of situations they experience it. SA was not part of my life until my 60s.

Bipolar I disorder in the DSM-V is well-known for having a co-occurring mental disorder with other disorders. This is especially true of anxiety disorders; for example: panic disorder, social anxiety disorder, and specific phobia. BPD occurs in approximately three-fourths of individuals with these disorders. Since 2007 I seem to have developed some degree of SAD. A psychopathological (chronic and disabling) form of social anxiety is called social anxiety disorder(SAD), and is a chronic problem that can result in a reduced quality of life as it interferes with the affected person's daily activities and socialization. Roughly 40 million American adults ages 18 and older (18.1%) have an anxiety disorder. The difference between social anxiety and normal apprehension of social situations is that SAD involves an intense feeling of fear in social situations and especially situations that are unfamiliar or in which one will be watched or evaluated by others. In my case, I have come to have a distaste of being in groups of more than 4.The feeling of fear can be extremely intense in these types of situations, occasionally causing a person to become so worried that he or she feels anxious just thinking about them and will go to great lengths to avoid them. SAD or just anxiety combines with fatigue after being in a social situation for more than an hour or two. This fatigue may also be due to effexor's side effects. For some people social anxiety can become a very difficult, painful and even disabling problem that is chronic in nature. That is not the case with me. The general anxiety disorder or social phobia test indicates that I do not have SAD.

A PROSE-POEM ENTITLED: SEROQUEL

SEROQUEL

A Peaceful New Meds Regime

Part 1:

In the period 16/4/'12 to 18/9/'15, I’ve been taking an anti-psychotic medication, seroquel, at various times in the evening from 8 pm to 11 pm. By 11 p.m. after taking the seroquel at 9:30 p.m., and after a busy day of writing and publishing in cyberspace, the somnolent affect, seroquel’s major side-affect, has set-in. Watching TV until sleep takes over is about all I’m good for. I don’t mind this; it is a peaceful way to end the day with my many hours(usually 6 to 8 per day) of writing & editing, poetizing & publishing behind me. My wife has usually gone to bed by 10:30; I also enjoy a late-night snack during the 10:30 to 12:00 period, as well as the pleasantly euphoric state that is the result of the medication. My body-mass index is now 29(BMI: July 2015) which is in the high-range of overweight; my aim is to get into the lower regions of the "overweight" category. I have noticed an decrease in appetite in the last 6 months on this new meds pkg; I have in fact lost some 20 pounds since late 2014.

This seroquel has been in my blood-stream now for 3 years and four months, and I have averaged 11 hours in bed daily for an 8 hour sleep. I won’t give you the details of my bi-polar (BPD) life from the age of 18 to 71, since I have provided a detailed outline of my experience of BPD over some 71 years in several places in cyberspace. I just want to comment here in this piece of writing on the activity of one of my late evenings, early nights, an activity that has taken-place due to the change in when I take my medication. the change was from about 11 p.m. to 1 a.m. in late March 2013 to what is now 9:30 to 10 pm. I watched parts of three programs on the old regime; each of these programs moved me to write this little prose-poetic piece.

Part 2:

Seven Ages of Britain is a BBC television documentary series which is written and presented by David Dimbleby(1938- ), the British BBC TV commentator and presenter of current affairs and political programmes. This seven part series was first aired on Sunday nights on BBC One in 2010. The series covers the history of Britain's greatest art and artefacts over the past 2000 years. Each episode covers a different period in British history. In Australia, all seven episodes aired on ABC1 in 2010; the series was repeated in 2013.

Last night was Part 6: The Age of Empire. The British Empire ended, as far as Dimbleby was concerned, in 1911; at least he saw 1911 as the year of the start of the decline of the British Empire. This program, indeed the whole series, would have been useful when I was a modern history teacher back in the early 1990s. Alas and alack, I am now retired from a 50 year student and employment life: 1949 to 1999, and I now do all my teaching in cyberspace in my role, my recreated self, as writer and author, poet and publisher.

Part 3:

The second program I watched last night thanks to my new meds regime on seroquel was entitled Seraphine. It was a deceptively subtle tale based on the true story of the life and art of a simple and single middle-aged maid. She was discovered by a German art critic in a small French town on the eve of the First World War. The protagonist, this maid-artist, is no tortured genius, nor an angry rebel, nor is she in some sexual whirlwind. She is beatifically happy in her gentle simplicity.

This cleaning-maid, self-made artist, becomes mentally-ill, and is put into a lunatic asylum. She achieves a strange kind of bliss, eventually stops painting, and dies in 1942; her art becomes famous and respected. I was fascinated by her obsession, her bliss, her love for art, for painting. The border-line between normality and mental-illness is also a theme which this film presents to viewers, as does the third, the following, program I watched last night.

Part 4:

This third program was a film I had first seen just after I retired from FT, PT and most volunteer work in the years 1999 to 2005. I only watched the last few scenes last night. Roger Ebert, the American journalist, film critic and screenwriter, who has been described as "the most powerful pundit in America," wrote about the main character in this film, Falling Down. “What is fascinating about the main character,” wrote Ebert, “is the core of sadness in his soul. By the time we meet him at the start of the film, he has gone over the edge: a psychotic break due to severe stress. But there is no exhilaration in his rampage, no release. He seems weary and confused, and seems to be running through some preordained script.” –Ron Price, Pioneering Over Five Epochs, 29/3/’13 to 8/3/'15.

In my 3 or 4 psychotic-breaks
I followed no script, but I was
weary and confused, sad and
withdrawn; I lived for a short
time in a parallel universe. It
was a strange place that I could
not leave fast enough...I was a
person pushed to the very limit
of my normal coping capacity!!

I was Mr Average Person & my
mental illness was due to events
both external and internal, stress,
a compilation of stressful events,
and body, a physical chemistry!!

Now I drift-off slowly on these
new meds, one an atypical anti-
psychotic which is a treatment
for my bipolar dis-order. This
tablet of: Quetiapine fumarate
is one of the most well-tolerated
neuroleptics of the many atypical
anti-psychotics, and it reduces the
incidence of any extrapyramidal
movement disorders, possible problem.

I’m on a low dose of 50 mg; it serves as
a binding agent of more and more serotonin
receptors; it is an H1 antagonist for the
H1 receptors in my brain with plenty of
histamine effects. I don’t really understand
all of this, but I can tell you: it helps me
to have a very good sleep after my 12 to 13 hours of domestic, family, social and literary life.(1)

It’s a peaceful new regime and I can
go the distance watching TV late in
the evening, and of my life, drifting-
off with my brain completely turned-
off after my day’s regime of lots and
lots of brain-and-intellectual activity.

(1) Quetiapine or seroquel is used for aggression, anger management, anxiety, bipolar maintenance, depression, mood disorder, PTSD, OCD, suicidal ideation, sleeplessness, borderline personality disorder, and Tourette syndrome, all of which have been part-&-parcel in complex and various ways, of my mental health issues over the years.

I'll cut-and-paste below the relevant part of a recent letter to a close friend in Canada, and add some details, to provide readers with a helpful picture of my current health due to its serious state, its debilitating aspects, the details of what has become a terminal illness according to several GPs and specialists in the last month. --------------------------------------------------------------------- Pancreatic Cancer Symptoms-August through September 2015

Part 1.1:

I was diagnosed with pancreatic cancer while in hospital for one week at the end of August and early September 2015. I had supporting statements of its inevitable terminal nature by two GPs in George Town, and a community nurse in Tasmania's palliative-care system. The following are the symptoms with which I have had to deal in the last two months, July through September 2015 and, to some extent for the previous four months depending, of course, on what particular symptom I am summarizing below.

There are usually no symptoms in the disease's early stages, and symptoms that are specific enough to suspect pancreatic cancer typically do not develop until the disease has reached an advanced stage. By the time of diagnosis, in my case in late August and early September, pancreatic cancer has often spread to other parts of the body. Risk factors for pancreatic cancer include: (i) tobacco smoking; but I smoked from 1964 to 1994 and, this risk factor is, therefore, not significant in my case after 20 years of not smoking; (ii) obesity(I was obese from 2010 to 2015), but my weight is now 'normal.' I was diagnosed in August 2015 with diabetes2; this is a risk factor.

Part 1.2:

Pancreatic cancer can be treated with surgery, radiotherapy, chemotherapy, palliative care, or a combination of these. Treatment options are partly based on the cancer stage. I will report on these options as they unfold in the months ahead, and as the stage on my cancer is defined in more detail than it now is. In 2012, pancreatic cancers of all types were the seventh most common cause of cancer deaths, resulting in 330,000 deaths globally. Survival beyond 5 years depends on the type of cancer. The survival range is from 5% to 65%, and I will know which one of the 14 types of cancer I have in the next three weeks. Wikipedia has a comprehensive outline of pancreatic cancer and I encourage readers to go to that site, if they have the interest.

Part 1.3: Symptoms

1. Yellowing of the skin and eyes are part of jaundice, a painless condition which commonly occurs in people with pancreatic cancer. It occurs when an increased level of bilirubin is in the blood. This can occur when a tumor completely or partially blocks a bile duct of the liver, slowing the flow of bile. I have had jaundice for some 7 weeks. A stent was inserted in my pancreatic system while in hospital in late August 2015. Those who want to know more about jaundice can easily locate the information in cyberspace. Since coming home from the hospital nearly two weeks ago, this yellowing has lessened.

2. Unintended weight loss is also a symptom of pancreatic cancer. While losing weight without trying may be welcomed by many, it can indicate something is wrong. It is one of the first symptoms of pancreatic cancer a person usually notices. I have slowly lost some 50 pounds in the last two years, and at an increasing rate as the year 2015 has advanced. One advantage of this process, if there is any, is that I no longer have problems with being overweight.

3. Nausea and/or vomiting is yet another symptom that is common in pancreatic cancer. These symptoms often result in a delay in a diagnosis as the patient tries to find out what is causing this nausea and or vomiting. These symptoms have been particularly present in my case in the last two months. I still have a mild nausea for which I am taking a medication. For the most part my diet consists of fluids like barley drink and water, chicken-noodle and beef soups, and sustagen. In the last few days I have begun to eat solids like: vanilla-custard, a chicken sandwich, watermelon and some of my wife's meals. My vomiting has stopped; it only took-place in and after being in the hospital when I drank too much.

4. Loss of appetite is a symptom of hundreds of diseases & conditions, including pancreatic cancer. It can signal something severe or even be related to something as small as a stomach virus. Medical procedures and scans, ultra-sound and tests of various kinds are necessary to make an accurate diagnosis of the various illnesses I now have. They have each and all confirmed my present disabling medical condition. I was diagnosed with pancreatic cancer, a terminal illness and, in my case, within 5 years I shall leave this mortal coil. This is the situation: a 90% chance of death within 5 years for those who contract this disease. This pancreatic-cancer disease has manifested these several symptoms enumerated here. My appetite is slowly returning after beginning a new medication in the last several days.

The several weeks of loss of appetite and these other symptoms have been a difficult period. Although, on the positive side and as I say above, I am no longer overweight. Even if all operations in the weeks and months ahead are successful, my life expectancy beyond five years is only 5 to 10 per cent.

5. Itchy skin is, perhaps, the most uncomfortable of all these symptoms. It is a less common symptom experienced by people with pancreatic cancer. When coupled with another symptom like jaundice, it can be significant in making a more accurate and timely diagnosis. Unfortunately, when someone with undiagnosed pancreatic cancer is experiencing itchy skin, it is often misdiagnosed as a dermatological condition. I have had a case of itchy skin for two months now increasing from week to week. The palliative care system in Tasmania, which I have become a part of in recent days, and my wife, are slowly sorting out this symptom of itchiness. Thankfully, though, I am the 1 in 10 who have this illness and experience no pain along with it. That is, indeed, a blessing!

6. Unexpected onset of diabetes 2 is, yet, another symptom. In some cases, pancreatic cancer may impede the pancreas's ability to produce insulin, resulting in diabetes 2. It is important to remember that most people develop diabetes 2 because of reasons unrelated to pancreatic cancer but, in my case, my diabetes 2 is part-and-parcel of my pancreatic problem. This is according to: (i) my gastroenterologist and (ii) my pancreatic surgeon who will remove the present blockage in an operation while I am in the hospital in October for two weeks if, indeed, I decide to go ahead with this operation. I am not sure, at this point in time, if I want to go ahead with the operation. I am waiting to have a PET scan on 17/9, and on 1/10 to attend a special clinic at the LGH for people with my particular level and type of medical malady.

7. Changes in stool and urine color are two final symptoms. Urine may become much darker, while stools lose their brown color, becoming a pale, clay/light color. This is often due to the bile duct being blocked. Stools can also have a odd, strong smell. While in hospital for a week in August-September 2015, I had an operation on my pancreas in which a stent was inserted; my stools are now back to a normal dark brown, although my urine is far more dark than it was my entire life.

---------------------------------------------------------------------
Part 2:

Some General Comments on My Health: 2014-2015

Part 2.1:

I have posted the above details due to the complexity of my present medical condition. Readers with an interest in its permutaions and combinations can Google to their hearts' content. The paragraphs above in relation to pancreatic cancer, and those below provide the information required to outline the details of my general health.

I see my GP several times a year and, more frequently, in the last two months. I have two GPs here in George Town, one for a second opinion. I see a psychiatrist once every three years now, usually to help me deal with medication changes for my bipolar I disorder. I also see a renal physician, or nephrologist, once a year for my moderate chronic kidney disease phase 3, a mild chronic obstructive pulmonary disease, and the fine-tuning of my blood pressure. I also see a urological surgeon once a year for my enlarged prostate; I see a gastroenterologist for several reasons: diverticulitis, blood loss in the gastrointestinal tract, a gastroscopy, and a periodic colonoscopy. In the last two months I also see a second gastroenterologist for diabetes2(D2), jaundice(J) and pancreatic cancer(PC) and, finally, a pancreatic surgeon for my ongoing pancreatic problems.

Part 2.2:

With a podiatrist for my foot fungus and various other foot problems, an optometrist/opthamologist for my cataracts, the side-effects of D2, and an annual update for my prescription glasses; with my dental work in the hands of 2 dentists and 2 dental technicians to help me take care of my two partial plates and my last 6 teeth; and, perhaps most importantly, with daily chats with my wife and with occasional chats with my son Daniel and my step-daughter Vivienne, who has been a nurse for 25 years, I am more than happy to pay tribute to the wonders of modern medicine in all its labyrinthine forms and sub-disciplines.

Whatever troubles the world is experiencing because of its ties with many outworn shibboleths in the fields of religion and politics, ethnic and nationalistic prejudices, failures to take science more seriously, problems associated with technology----the science of medicine among other sciences and technologies has transformed and continues to transform our world, at least for those like myself who have the advantage of being able to access medicine's several specializations and fields, and those of science and technology, especially the IT industry.

Part 2.3:

​For those who are into the vast tracts of alternative medicine, I am happy that you NOT write to me with your concerns and your advice for my several medical problems. I am in VERY good medical hands, and am enjoying the pleasures of retirement as I go through my 70s. I have many local people who provide me with curative advice in the areas of alternative medicine, and several who provide me with: (i) supplements and aromas, (ii) medicines, and particular vitamins and minerals, and (iii) an assortment of meditation, yoga and mental hygiene techniques. It must be said, though, that I now use the many forms of alternative medicine very rarely.

​ I also have access to: (a) homeopathy, (b) naturopathy, (c) chiropractic, (d) osteopathy, (e) energy medicine, (f) various forms of acupuncture, (g) traditional Chinese medicine, (h) Ayurvedic medicine, (i) Bowen therapy, and (j) a wide range of faith healing prescriptions. The internet, too, is full to overflowing with advice that I can access 24/7. I have benefited for decades, indeed, since my childhood, from advice in the many healing arts thanks to a mother for whom the subjects of healing and health were at the center of her religious proclivities, and a wife who takes more than a little interest in both science and medicine.

Part 2.4:

I now benefit on a daily basis, as I say, from having a wife who knows more about anatomy, physiology and general medicine(due to her interests in science and her own health problems) than I will ever know. She has proved a useful helpmate in our four decades of marriage(1975-2015).

CONCLUDING WORDS

I trust the above provides a more than adequate account of my 72 years of dealing with BPD. As my months and years go through these middle years(65-75) of late adulthood(60-80), I will add more to this 15th edition, this account. I will do more editing, and make this 15th edition for 2015, more complete as we go through the year 2015.

Ron Price
15th Edition
Draft Number 2
8/8/'15.
350 Pages(font 14)....No of Words: 140,000
400 words per page on average....
ronprice9@gmail.com
Tel:03-63824790(from mainland Australia)
Tel: dial the international access code #
and then: 613-63824790(from overseas)

6 Reece Street
Pipe Clay Bay
South George Town
George Town Tasmania 7253
Australia

INTRODUCTION TO THE FOLLOWING TEN APPENDICES

The following TEN appendices embellish the above account for the special interest of some readers and for my own purposes. These appendices give this account a greater degree of comprehensiveness and utility for different contexts, contexts of use to either myself or others, or both. For a more fully comprehensive statement, of course, readers need to see this statement in the context of my five volume, 2600 page, autobiography available at Baha’i Library Online.

APPENDIX 1:

My statement from the first year with my present psychiatrist is found in the following appendix. I have given this statement the title: THE STATEMENT RESULTING FROM THE LAST 2 CONSULTATIONS WITH MY PREVIOUS PSYCHIATRIST. I was with my previous psychiatrist from April 2001 to April 2012. I have had a new psychiatrist from April 2012.

DATES OF THOSE LAST TWO CONSULTATIONS: 30 NOVEMBER 2007 AND 13 NOVEMBER 2008

Preamble:

My aim here is to state as succinctly as possible the new set of symptoms as they had developed by November 2007 since I began a new medication package of sodium valproate(NAVAL) and venlafaxine(effexor) in April/May of 2007. These symptoms were exhibited firstly, as of 30 November 2007, the date of the first consultation summarised below with my psychiatrist; and secondly, as of 13 November 2008, the date of my final consultation. I have now had seven years(2001-2008) of very helpful consultations with my psychiatrist in Launceston Tasmania. I have not visited him since November 2008 and, since I now have a new psychiatrist with whom I am happy, I will not see him again. He was a specialist in treating BPD, although I know from my long experience in having my BPD treated, that both professionals and non-professionals all have their own inevitably subjective evaluations and estimations(as I have mine) of the expertise or non-expertise of the quality of such professional service. I was under the care of this previous psychiatrist for 11 years.

A second aim here is to write the account of the experience and the results of each of my consultations, beginning with the one on 30/11/07 and ending with the last one on 13/11/’08. I have been keeping such summaries since 2001, but in a more cursory note-taking fashion. These are, as I say, my thoughts and experiences relevant to the new medication package and in more detail than my notes had been from 2001 to 2007. In this way I am able to state before, during and after the consultation, the latest symptoms that concern me in a more reflective and summary fashion than in the somewhat spontaneous and less-thought-out manner than is usually the case when I meet in each session with my psychiatrist.

This statement below will also serve to outline the process and the results of these consultations and future ones for use by myself and relevant others: (a) with whom I correspond, especially on the internet at mental health, BPD and D sites; (b) whom I feel would benefit from knowing about my most recent experience with BPD; and (c) who would benefit from having such statements as part of their official/formal evaluation of my illness.

This statement below is written to include the points raised and not raised during our consultation as well as the decisions and suggested directions we reached. -Ron Price: Statement A, 3/12/’07 and Statement B, 13/11/’08.

A. Discussion & Decisions From Psychiatric Consultation:30/11/07

1. CONCERNS ABOUT SLEEPING:

From my wife’s point of view I am “falling asleep all the time.” My behaviour was not frenetic and overactive, as it had been before I had gone on this new package of meds. This frenetic/overactive behaviour was the main reason for going on these meds. My behaviour was also somnolent and far too sleepy for a normal person. It was this concern of both my wife and I which led us to feel that a visit to my psychiatrist on 30/11/07 would be useful. The new pattern of sleeping behaviour that has become apparent after eight months on this new medication package(4/07 to 11/07) contains the following details:

1. Alternating periods of fatigue, a slight shortage of breath and sleepiness on the one hand; and energy and enthusiasm for my academic/literary work on the other—often within a few minutes. To put this sleeping pattern in a more precise way, there are several aspects of sleep, sleepiness and wakefulness that I would now like to outline:

(i)       when I stop working(i.e. stop reading and writing), I fall asleep: (a) in front of the TV, (b) when I am just gazing out the window or (c) when my mind is not engaged to its full extent, as it is in my mental/writing work;

(ii)       often when I am reading and writing I get so sleepy I have to: (a) go for a walk, (b) take a break and/or (c) have a sleep;

(iii)       I sleep for: (a) 1 to 2 hours in the afternoon or evening and then go to bed between 1 a.m. and 5 a.m.; or (b) 1 to 2 hours on going to bed at 11 p.m. with my wife and then I wake-up about two hours later, about 1 a.m. In this pattern I get out of bed and stay up for 2 to 4 hours. I then go back to bed for 4 to 6 hours-getting out of bed finally at 10 to 12 noon; and

(iv)       (a) I am awake until the very late hours of the night, as I indicated in (iii) above, usually until 2 or 5 a.m. Then I sleep until 10 to noon with an hour or two of sleep in the late afternoon or after dinner; (b) My reading and writing tends to be in short bursts adding up to an 8 hour total of literary work per 24 hour period; and (c) I have short bursts of other activities: domestic, social and, personal--adding up to another 8 hours.

2. CONCERNS ABOUT OBSESSIVE-COMPULSIVE DISORDER:

I seem to exhibit more OCD, obsessive-compulsive disorder, behaviour: straightening & squaring bits of paper, magazines & newspapers on tables and desks and other forms of tidiness much more than in previous years on lithium—again this is of more concern to my wife. After my description of what I felt to be OCD behaviour, my doctor felt my behaviour in this area was not OCD, only a behavioural abnormality associated with my activity base and style of life.

3. CONCERNS ABOUT URINATION:

I am urinating on average every 80 minutes. I calculated this statistical average in September 2007 and the psychiatrist said this was normal/average for my lithium toxicity history.

4. CONCERNS ABOUT DREAMING:

I have a nightly dream pattern that is more extensive than ever before in my life. This leaves me with a dense-and-heavy, somewhat disoriented, feeling on waking, a feeling which goes away quickly. Often it takes me an hour or so to get to sleep; I often sleep lightly. On waking I often: (a) stay in bed and go back to sleep, (b) get up and go back to bed and sleep or (c) get up anyway and get a rested feeling after a shower, etc. The doctor said this extensive dreaming was also a normal reaction to the new medication of effexor.

5. CONCERNS ABOUT WEARINESS & SIGNIFICANT OTHERS:

5.1 I get a feeling of emotional and psychological weariness, what used to be popularly called tedium vitae, late at night after: (i) 8 hours of literary work and (ii) a degree of hyperactivity in the previous 24 hour period. In some ways this a somewhat natural feeling given the extent of my literary and academic work. A quiet and low-key death wish usually accompanies this feeling. My psychiatrist was not concerned about this issue since we had talked about it on several occasions from 2001 to 2007, and neither he nor I felt the need to discuss it during this consultation since: (i) my new meds had taken away the blackness associated with this death wish and (ii) the grey feeling and not-black was a big improvement. After many years of the death wish the downside of my condition had been ameliorated and I was not troubled to the same extent as before. I simply accepted the greyness as a normal experience before sleeping.

5.2 The significant others in my life are an important source of: (a) concern to me and (b) relevant feedback. Since I have been on this new medication my wife has come to accept my sleeping eccentricities. We now know what happens as a result of decreasing the level of effexor and I write about this elsewhere in this lengthy account. She has noted that I am given to: (a) inappropriateness of verbal responses in some social situations, and this is still a concern; (b) an increase in OCD behaviour, easy distraction by details or perfectionism--whatever one might call this behavioural pattern--and (c) speeding, a mild degree of rapid cycling, racing ideas or hyper-energetic behaviour when it was not necessary. My wife and I occasionally talk about other/new treatment regimens due to my sleeping so much of the time and me being not my old self, my more hermetic existence—not the meeting-goer I once was. The psychiatrist and I did not discuss these aspects of my behaviour.

6. CONCLUSIONS AND WHERE TO GO FROM HERE:

The above served as a basis for discussion and was altered after our consultation so that this statement, draft #2, would include the decisions we arrived at and the items discussed and not discussed, for my record. During our consultation on 30 November 2007(4:30-5:00 p.m.), we decided that the best course of action to take in relation to the above behaviour/symptoms was:

(i) stay on the present levels of effexor(150 mgr/day) or (b) reduce the effexor by 37 ½ mgr; then reduce it again by another 37 ½ mgr. until a review with him at my next visit. I went on effexor in April 2007 because I was not sleeping much, had what might be called agitation/insomnia and life was far too frenetic/active. This is not now the case. I am sleeping from 6 to 8 hours every day, but my sleeping patterns are abnormal/erratic/unconventional and I hope to normalise them by reducing the levels of effexor as suggested in section A above.

(ii) There may be no change in my sleeping patters, even if I reduce the effexor said the doctor. If I seem to be okay, that is: (i) if I am sleeping well with little agitation, insomnia and not too active, as I am at present; or (ii) if I am not too sleepy as I was at first, then, perhaps, I can go off the effexor entirely after the 2 stages suggested in section A above.

(iii) I received 4 prescriptions: 3 for effexor(150, 37.5 and 75 mgr. tabs) and one for sodium valproate. I will get the prescriptions filled when and if it is appropriate and apply them as I decide in the weeks ahead. When additional medications are required I will get a script from my GP not my psychiatrist.--Ron Price 3 December 2007.

B. Discussion & Decisions From Psychiatric Consultation:13/11/’08

The main purpose of this consultation was to review the developments in the last year since the last visit to my psychiatrist on 30/11/’08. Since that last visit in November 2007, I have reduced my effexor from 150 mgr per day to 112 and ½ in 12/’07 and then to 75 mgr in 2/’08, as suggested by the psychiatrist that I do this when and if I felt it was appropriate. Since the effexor was now(11/’08) functioning at what he called “a sub-clinical level,” he said that I needed to reduce the effexor further. It was, then, decided that:

(i) if: (a) the NAVAL level was within the normal range of 350 to 700; (b) the creatinine level was ‘satisfactory’, (c) the eGFR level for kidney function and (d) the index of liver function was ‘satisfactory,’ as determined by the eGFR(the globular filtration rate)---all of which would be determined by a blood test on 18/11/’08---I would then: (i) reduce the effexor level to 37 and ½ mg. for two weeks, (ii) go off the effexor entirely; (10/12/’08) and (ii) if any problems arose during the above process, I would contact my psychiatrist right away.

The most common sleep pattern/rhythm that has developed in the last year has been as follows: (a) go to sleep between midnight and 3 a.m., (b) go to sleep until anywhere from 9 a.m. to 11 a.m.; and (c) then sleep another hour during the day and/or evening. My wife and I have adjusted to this pattern. As my wife puts it: “when I stop writing at my computer or doing household tasks I often/ immediately get sleepy.” This problem was discussed and it was decided that:

(a) I would continue with this sleeping pattern until my wife and I wanted to see a change in this sleep pattern.; and (b) if she and I wanted me to have a normal sleeping regimen, that is, from midnight to 8 a.m., we would have to make a greater effort to regularize my pattern into this framework.

Finally, my lifestyle has become more hermetic since going on this new medication. I had been a more gregarious person in the past. No decision was arrived at in relation to this ongoing psycho-social problem of a desire for increased social isolation and hermeticism. Other topics were discussed during this consultation on 13/11/’08 such as: (j) symptoms of BPD before its clear onset in my life in adolescence, (ii) when to come for the next visit and (iii) when my psychiatrist plans to retire, but no notes were kept on these matters. The next visit will be, as this one was, on a needs basis.—Ron Price, 13/11/’08.

Note: the effexor was reduced to 37 and ½ mg./day on 26/11 and then eliminated on 10/12/’08. No noticeable change in behaviour/symptoms resulted, at least not in the first week, and, thus, there was no need to consult my psychiatrist. Again, I shall report on this in the months ahead.

APPENDIX 2:

THE 5-AXIS SYSTEM OF DIAGNOSIS

1.1 The diagnosis that has been made in my case, in addition to the several I have been given in more than forty years(1968-2011) is a diagnosis that is standardized according to The Diagnostic and Statistical Manual of Mental Disorders (DSMMD-4th ed’n-1994) which provides diagnostic criteria for mental disorders. In DSMMD there is a 5 axis/level system of diagnosis that is used and, in my case, axis/level 1 is for clinical disorders that are mood disorder. Axis 3 in this system is for what DSMMD refers to as acute medical concerns that relate to BPD; axis-4 is for psycho-social and environmental problems that contribute to BPD and axis-5 is an overall caregiver’s assessment of my functioning on a scale 1 to 100. In my case, my caregiver, namely my wife, has evaluated me at 61-70 on the numeric scale which reads as follows: “this adult has some mild symptoms of BPD with some difficulty in social and occupational functioning. Generally, though, he functions pretty well. He also has some meaningful interpersonal relationships."

1.2 Government departments, as I mentioned above, set the bar high for the allocation of a caregiver’s Allowance and I do not exhibit bad enough symptoms, that is, symptoms below, say, 50 on the scale 1 to 100. Readers wanting a copy of this diagnostic tool can easily find it on the internet. I have appended this tool to this statement in appendix 3 below.

APPENDIX 3:

THE GLOBAL ASSESSMENT OF FUNCTIONING: A NUMERIC SCALE

The Global Assessment of Functioning (GAF) is a numeric scale (0 through 100) used by mental health clinicians and doctors to rate the social, occupational and psychological functioning of adults. 91-100 Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her many qualities. No symptoms.

81-90 Absent or minimal symptoms, good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns.

71-80 If symptoms are present they are transient and expectable reactions to psychosocial stresses; no more than slight impairment in social, occupational, or school functioning.

61-70 Some mild symptoms OR some difficulty in social, occupational, or school functioning, but generally functioning pretty well, has some meaningful interpersonal relationships.(Note: my caregiver, namely, my wife, assessed/rated my functioning at this numeric level).
51-60 Moderate symptoms OR any moderate difficulty in social, occupational, or school functioning.

41-50 Serious symptoms OR any serious impairment in social, occupational, or school functioning.

31-40 Some impairment in reality testing or communication OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood.

21-30 Behaviour is considerably influenced by delusions or hallucinations OR serious impairment in communications or judgment OR inability to function in all areas.

11-20 Some danger of hurting self or others; or occasionally fails to maintain minimal personal hygiene; or gross communication impairment.

1-10 Persistent danger of severely hurting self or others OR persistent inability to maintain minimum personal hygiene OR serious suicidal act with clear expectation of death.

0 Not enough information available to provide GAF.
_____________________________________________________
APPENDIX 4:(Personality Test: completed from 21/1/’12 to 21/3/'15 during my life from age 68 to 70.

A. PERSONALITY TEST

There are many personality tests and the following is a simple one based on Four Temperaments and a theory of proto-psychology. The theory has ancient medical roots and is intended to provide personality traits and behaviors. I utilize it here since my BPD takes place within this personality construct. There are many personality tests and ways to analyse the self. I have included one test and one typology in this appendix to my account of BPD because of the light thrown on my life in the process. The more I read of these personality analyses the more aware I became of how inadequate they were on the one hand, but also how useful they were on the other.

Sanguine- Overview

Easily excited by external influences, reacting quickly, although the impression is often short-lived. There is somewhat of a superficiality, or better said, lack of depth (part v. whole relationship), in the sanguine personality. The sanguine commonly follows others and has little stability as a result. Fickle in ideas, opinions, and resolutions. Changes moods often (from laughter to tears in a matter of seconds). The sanguine rarely internalizes his/her focus and instead devotes attention to the external (his/her appearance, and of others, to beautiful faces, fashions and manners). The sanguine is full of optimism.

Sanguine- The not so great Characteristics

Vanity and self-complacency, loving the appearance of his/herself and the praise of others. The sanguine is very inclined to flirt, and has a great degree of jealous tendencies. The sanguine cannot be left alone. There is a cheerfulness and love of pleasure that accompany the desire to always have someone around to enjoy life with. The sanguine decision are likely to be the wrong decisions, their undertakings fail easily since they believe success is inevitable and will therefore take it for granted; they are unstable, and they have little understanding of themselves since they rarely internalize conflict.

Sanguine- The wonderful Characteristics

Everyone loves & knows the sanguine. He/she has the most friends & easily makes new friends.This is the extrovert of the 4 temperaments. The sanguine is extremely friendly, pleasant, and willing to accommodate. Is often found entertaining others, is compassionate towards others, and is graced with the gift of calling others out on their faults without bringing humiliation or displeasure. Very virtuous. Rarely shows resentment or defiance. Wishes the best for everyone.

Melancholic- Overview

Like the Sanguine, the Melancholic is also easily excited by things. However, unlike the Sanguine, the initial reaction of excitement is weak, but the impression remains long and grows stronger by subsequent impressions of a similar nature. A person of this temperament is inclined to deep, thoughts and reflection, dwelling the past, looking ahead to the future, is very profound, finds meaning in just about everything, & is not satisfied with the superficial. The melancholic is driven by laws & principles. The melancholic is most comfortable alone, and in silence. He/she is very introspective and always sees life from a serious perspective, often feeling burdened and brought down by temporal affairs. Melancholic types are commonly passive, reserved, irresolute, despondent, lacking courage, slow in thought and speech. Melancholies despise the limelight.They would rather withdraw & let others receive recognition, even when they are praise worthy.

Melancholic- The not so great Characteristics

Easily falls into mental distress and this can be extremely intense. The melancholic, more than any other temperament, has keen awareness of moral right and wrong, and has a deep longing for morality. They are inclined to despair, intense expressions of grief, and occurrences of depression. This can result in self-pity, and he/she may become a burden to friends and family. He/she can also lose confidence in others, specifically superiors; there is a loss of trust and respect when the melancholy becomes aware of a fellow man's weaknesses and faults. The melancholy vehemently desires justice, and forgiveness of offences is hardly an option. He/she is suspicious, lacks trust in people and fears that everyone is out to get him/her. He/she is pessimistic about everything.

Melancholic- The wonderful Characteristics

Loves solitude and is often productive in solitary hobbies encompassing the fine arts, liberal arts, crafts, writing, analytics, drama, contributing deep and profound thoughts and ideas to poetics, philosophy, science, and legislation, etc. There is a joy and a relaxation that results in the melancholic devoting time to these activities. Melancholies are excellent counsellors to friends, encouragers, give great affirmation when necessary, they are trustworthy & genuine. They are willing to make extreme sacrifices for the sake of others.

The above typology or characterization is a useful one in providing an overall context for the expression of bipolarity in my life and my life with my wife. The above two personality types are very explanatory and I have tried to place them in the context of my life from childhood to late adulthood.

B. As a typology the Enneagram defines nine personality types which are represented by the points of a geometric figure called an enneagram. The enneagram also indicates some of the connections between the types. As there are different schools of thought among Enneagram theorists about some aspects of how it is understood, its interpretation is not always unified or consistent. It has been described as a method for self-understanding and self-development, but has been criticized as being subject to interpretation, making it difficult to test or validate scientifically. A person may be understood to have a core type and one or two wing types that influence but do not change the core type.

However good a piece of writing may be, taken quite apart from its creator, the fact that it is or is not another expression of the personality of a particular artist is important. For it either is or is not an addition to our knowledge of that artist; a further revelation of that mysterious, indefinable and fascinating thing—his personality. (D. W. Winnicott, quoted in Anthony Storr, The Dynamics of Creation, 58.) The nature of creativity will probably always remain mysterious because its basis is irrational—in the feelings and unconscious of those who create—and because, as Winnicott notes, part of the motive for creating is to remain concealed, to be unfound by others. Yet the motives given for artistic work—to communicate and to conceal the self—are but two possible motives which any person may have for creating. These two motives are, however, particularly appropriate to the artistic temperament among the personality types. Of course, members of any other personality type can become artists in the sense of making a livelihood by producing works of art, however that is defined. The person with an artistic temperament, however, is in search of identity, and art is the foremost means they have of finding themselves, as well as their way of reporting to the world what they have discovered. The person with an artistic temperament is the personality type which emphasizes the subjective world of feelings, in creativity & individualism, in introversion & self-absorption, and in self-torment and self-hatred. In this personality type we see creative artists, romantic aesthetes, and withdrawn dreamers, people with powerful feelings who feel different from others because self-consciousness blocks them from getting outside themselves.

People with this temperament are the most self-aware of the 9 major types, and this is the basis of what is most positive and negative about them. The constant conflict we see in them is between their need to be aware of themselves, so they can find themselves, and, at the same time, their need to move beyond self-awareness, so they will not be trapped in self-consciousness. The tension between self-awareness and self-transcendence can be resolved in creativity. In the creative moment, healthy people of this type harness their emotions without constricting them, not only producing something beautiful but discovering who they are. In the moment of inspiration, they are, paradoxically both most themselves & most liberated from themselves. This is why all forms of creativity are so valued by them, and why in its inspired state, creativity is so hard to sustain. They can be inspired only if they have first transcended themselves, something which is extremely threatening to their self-awareness. In a sense, then, only by learning not to look for themselves will they find themselves and renew themselves in the process.

The overall direction of their personalities therefore is inward, toward increasing self-absorption. This is because they feel that they are different from other people, and they want to know why they feel this way. Ironically, however, they try to find their place in life by withdrawing from it so they can trace the labyrinth of their emotions. But the result of their withdrawal is that even average people of this type have noticeable difficulties coping with life, while unhealthy people of this type have some of the most severe emotional difficulties of all the personality types.

Their feeling states and self-image become rarefied to a degree that reality will not support. Increasingly, they begin to withdraw from life and real relationships and experiences, both to prevent others from interfering with their strong reveries and moods, and to avoid potential embarrassment and humiliation. As they draw the curtains and turn away from life, however, they cut themselves off from the wellspring of their feelings and their creativity—participation in the world. In healthy people of this type, however, the rich life of the unconscious becomes accessible and is given shape. More than any other personality type, they are the bridge between the spiritual and the animal in human nature because they are so aware of these two sides of themselves. They sense in themselves the depths to which human beings can descend, as well as the heights to which they can be swept up. No other personality type is as habitually aware of the potentials & predicaments of human nature: human beings are spiritual animals occupying an uneasy place between two orders of existence. This person senses both sides of their potentially conflicting natures, and they suffer intensely or are ecstatic because of them. This is why, at their best, healthy people of this type create something which can move others deeply because they have been able to get in touch with the hidden depths of human nature by delving deeply into their own. By doing so, they transcend themselves, and are able to discover something universal about human nature, fusing personal conflicts and divergent feelings into art.

There are many personality tests and ways to analyse the self. I have included the above an an appendix to my account of BPD because of the light thrown on my life in the process.

APPENDIX 5: VISITS TO DOCTORS MEDICAL INFORMATION SHEET

No.12(go to diary>bipolar>medical>blood test 6-2013-in computer directory) I keep this file up-to-date, but after 2013 the information is not included here. I update this file and the most recent update is to January 2015, but it is not included below.

PREAMBLE:Part 1

The following two preambles outline: (a) what this Sheet No. 12 provides, that is, information that is kept for: self, doctors and relevant others. The record of sheets 1 to 11 was begun at age 55 on my early retirement and on moving to Tasmania from Western Australia for a sea-change. Sheet No. 12 is for age 68.4-69.4(to end of 2013), (b) what Sheet No. 11 and others provide, namely, my medical record back to the age of 59. See my personal Medical Files(Section E.2.1 and 2.2) in my brown brief-case under my desk for all blood test results before the present. Not all history details are kept on file for this period 1999 to 2013, just a working base for practical use, and (c) a summary of my recent experience with each of my doctors.

1. I saw Dr Richard Ayling in 2005 in L’ton at the Summerdale Medical Centre(63447177)

2. I stopped seeing Dr E. Ratcliffe at 155 George Street(63312122) in 2009. Dr Johl--private: 63344866 at 166 St. John St. 2 days-Tu/Th-private on 0408128700. He is at the LGH 3 days a week: M,W, & F—63487111. There are two other psychiatrists at the LGH-options from 2009-2012. I have never seen any of these doctors.

3.I began seeing the psychiatrist Dr George Hyde in April 2012, 166 St. John St.-63340188, a private practice. Saw him 4 times in April to August 2012.

4.1 I began seeing an optometrist named Donald in 2012, and Frances in 2013. I will get a letter in January 2014 to have my next eye-test in George Town. This will also be a test for glaucoma and the development of my cataracts. I have 2 cataracts in the right eye, and 1 in the left(age-related).(tel # to book a test: 1300 139363).

4.2 Private Health Care with CBHS is cheaper than Dept of Health and HS. My glasses were fixed on 10/9/’12 for free, that is, the frame and screws. Options: (Kiah=receptionist). Keep the glasses(frames and lens) I’ve got until I sit on them. When I’ve sat on them, then come in with Chris and get a new frame(covered by medical benefits)(CBHS). Before getting the new frame, discuss the question of a new lens $319 or $379(29/1/’13) with clip-ons for $300. The lens mentioned above takes away the glare and they have a hard-coating; CBHS probably covers 50%.

PREAMBLE: Part 2:

5. I began seeing the renal physician Dr Rajesh Raj on 16/10/’12; I saw him again on 27/11 at 2:20, and my next appointment is on 21/5/13 at 2 pm after a blood test in early May 2013. Dr Raj advised that: (a) I see Dr Monsaur in his private rooms; (63315800-26 Lyttleton St); (ii) I had a constriction in my urethra due to an enlarged prostate, and that was why I needed to see the urologist, Dr Monsour, and (c) I need to have a blood test circa 7 May 2013 at Launceston Pathology(71 Frederick St-63343636). I will now see Dr Raj twice a year.

6. My 2nd visit with Dr Michael Monsour was on 15/2/’13; the first was in 2009. Ultrasound and CT Scan (Computed Tomography) are two of the most widely used medical imaging techniques. The techniques use different principles to generate an image for diagnostic purposes. The results of my CT scans and ultra-sound, done in November 2012 at Regional Imaging Tasmania (RIT), the major provider of medical imaging services in North and North-West Tasmania, and requested by my renal physician, Dr Rajesh Raj, are as follows:

1.1 I do not need a cystoscope(with gel) up my urethra to check on the multiple-and-simple cysts on my kidney, and the moderate thickening of my bladder.

1.2 the degree of the constriction in my urethra due to my enlarged prostate, an enlargement Dr Monsour first investigated in 2009, is as follows: (a) it is slowly enlarging, and (b) whatever problem arises depends on whether the process of enlarging grows inward or outward thus affecting the size of the urination-hole. I get-up 3 to 4 times a night,

1.3 It will not be necessary for me to have a reboring which is a surgical procedure with its dangers of infection and tearing.

1.4 I got a script for a medication known as duodart. I will take 1 tablet/day and it is taken ½ hour after eating at the same time every day. This medication may have side-effects, and if they are bad enough, for example, dizziness and/or light-headedness, then stop the duodart. I took my first pill on 17/2/’13. This may take a few days to integrate into my seroquel and effexor medications, and my vitamin & mineral daily package.
1.5 I made an appointment to see Dr Monsour again on Thursday 13/6/’13 at noon. The Medicare costing schedule is as follows: $145 for the first consultation with a $72 rebate, and $75 for the 2nd consultation in June 2013 with a $35.90 rebate from Medicare. Dr Monsour will send Dr Z a copy of his recommendation.

1.6 I urinate, on average, once every hour during the day, and get up 3 to 4 times a night. I am not having any discomfort urinating; the new meds should help me empty my bladder of the 90 ml that are there even after urinating.

1.7 My MCKD(moderate chronic kidney disease) phase 3 is not causing me any pain and there is no blood in my urine or weight loss. Therefore no serious problem is indicated. If the constriction in my urethra increases in size, though, there is a risk it could affect my kidneys and, therefore, my MCKD phase 3.

1.8 I need to clean my foreskin daily and dry it if possible to be sure that no infection occurs in that area of my penis.

7. I saw Dr Jane Zimmerman for a complete medical on Monday 7/1/13(2:00), and I will have another one on or about 7/1/’14. I will have a hearing test on 3 April at 8:30 followed by a visit with Dr Z at 9 a.m. My next blood test is on 11/’13 followed by a visit to Dr Z one week later.(this appointment has not yet been made).

7.2 Dr Jane Zimmerman: Discuss the following on 3 April: 1. Dr Monsour: 15/2/’13; 2. hearing test-result.

8.1 Dr Barry Gilbert gave me referral on 26/9 for me to see the Renal Physician, Dr Raj Rajesh. He faxed through to Dr Rajesh’s rooms and I saw him on 16/10/’12 at 3:00 pm. $200 up-front and $125.90 back from Medicare(I gave Mandy my bank details)-63344188 at St. Luke’s, 16 Lyttleton St in L’ton

8.2 On 13/12/’12 I discussed the results of a hearing test. He said: (a) come back for a test in 3 months. I have made an apt on 3 April at 8:30, (b) I may have an acoustic neuroma(see info sheets); I will decide whether to have an MRI scan after next visit on 3/4/’13 with Dr Z; and (c) hearing in right ear is fine, left ear significant hearing loss.

A. ITEMS TESTED IN THE BLOOD:

The information below, the record of my: (A) blood test data, (B) non-blood test data and (C) other data(current and historical) is for my use in determining: (i) when to do the next tests, (ii) what to discuss with my GP, Dr Jane Zimmerman, Dr Dawson or Dr Barry Gilbert in George Town at my next visit (63824333-Box 163: twice a year as of 2011). Chris Price’s mobile is: 0427755093 and I need this number occasionally for medical purposes.

1. Triglycerides: see blood test file OMACOR-the best fish oil-10/4/12(too expensive-6/’12)

2. Cholesterol*(fasting required) 2.1 LDLs and HDLs-see blood test file; 20 min. aerobic type walking every day(begun ASAP) COPD-30 min. non-aerobic walking every day(begun 1980s); Discussion of Cholesterol in 2004/5:(a) medication-lipitor—decided: (i) it was too expensive($60/month & only if my reading is 7.5 & over) and (ii) take it when I am much older & over 7.5; (b) foods discussed with Dr. Ayling to lower cholest; (c) aerobics exercise required to lower LDHs; (d) Dr. R said I should aim for an overall reading of 4.4 or below. To achieve this I should: (i) walk 1/2-1 hour per day and puff for 20 minutes and (ii) watch diet--more avocados & oatmeal & less cheese, bickies & sugar.

THE lithium BLOOD TESTS WERE DISCONTINUED in APRIL 2007--That information is now archived.

Blood Tests Below Were Continued After April 2007:

3.(a) For Kidney Function: The creatinine and urea levels are indicators of KF. *1. Creatinine: see blood test results 1.I had an ultra sound(US) for renal function...on 24/11/08. Creatinine readings here should be less than 106; creatinine levels are high. I am waiting for a letter from an urologist for possible medication. Frequent urination started in 2002/3. I got some internet notes on eGFR(see Medical File Section D: BPD) (eGFR=33, 37, 32-on 31/10/’12) Dr. Z said (a) I have a “phase 3 moderate chronic kidney disease(MCKD)’& (b) phase 5 was a crisis state and I would have to go on a dialysis machine. Drink 2 litres of water per day.

2.Saw a renal physician, Dr Raj(16 Lyttleton) on 16/10/’12 before my 2nd visit to the urologist(first visit on 9/2/09). I had a range of blood tests on 16/10 and had an X-ray(11:15 on 14/11/’12) and ultra-sound test on 14/11/12 at 11:30 to noon at St. Vincents(3 to 4 glasses of water; 300 ml of urine)(Dr Raj said I do not empty my entire bladder of urine)

I saw Dr Begum on 27/11/’08 and she advised, as a result of the ultrasound-X-rays, I had in L’ton, that I: (i) collect my urine from 2:30-1/12 to 2:30-2/12/’08;(result: 2.89 litres collected) (ii) have a blood test on 2/12—for urologist in L’ton: Dr. Monsaur at LGH Admission Office: 63487391. I collected my urine again on 7/09: 3 litres & 24 times. This specialist clinic sent me a letter to discuss my kidney function, my thick bladder and the multiple cysts on kidney with Dr. M.J. Monsour. If there is an obstruction (cyst=kidney/thickening=bladder), it may have to be removed or it may not be serious.

3.The job was done at the LGH at their specialist clinic. I call 63487111 and ask to speak to the specialist clinic. Dr Mike J. Monsour on 2/2/’09 gave me a FUB. See above for Dr Monsour.

4.Signs of MCKD problems to cause me concern are: pain, blood in urine, weight loss. If none of these I should not worry about my MCKD. The 1st signs of serious, acute or chronic renal failure/problem are: (a) creatinine level test in blood; (b) an early prostate problem, and (c) if I have trouble urinating. Since I urinate every 30 to 80 minutes I do not have an acute/serious problem.

4.Urea:-see blood test results

5.For Sodium Valproate and Effexor-see blood test results; NAVAL-discontinued in April 2012. Effexor-75 mg/day -I do not keep a record of my scripts as of September 2012.

(c) Other Blood Tests For Other Problems:

6.Liver: The results for each year of this annual blood test beginning in 2003 were all okay. Do a magnetic resonance imaging test, if there is a problem. Had a liver function test(LFT) on 18/11/08. Have one every year from 2011 onwards.

7. Haemoglobin(Red Blood Cells)-see blood test resultsRange: (130 to 175)(or 140 to 180)( or 4.8mmol/L to 5.2)( or 8.7 to 11.2) ….154-28/11/’11; 134-22/4/’12: at Red Cross Blood donation

8. Blood Pressure 130/80=average; 142/79-22/4/’12; 119/74-7/10; 149/89-11/09 157/95 on 23/7/’12; 150/90 & 147/95 on 15/8/’12. I do not have high blood pressure; decision on 15/8/’12

9.Type-2 Diabetes: (blood glucose)4/05(4.7), 10/06(5.2), 12/07(4.5). Test is done with cholesterol every 12/mo. Tests: 12/08:-5.1; 1/10-5.0; 10/10-5.2 fasting required-result needs to be below 5.5. It was 5.3 on 10/’12.

10. Thyroid Tests: twice in 2004, and annually from 2005.

11. Vitamin D-blood test in 10/10. Result: low-take Vit D-supplement. I have been taking it since 10/10(400 IUs) and (1000 IUs). Blood test results in 11/11-okay. Started to take 1000 more IU as of 1 July 2011.(get blood-test results on 31/10/’12. Should be more than 74; I’m 84 on 31/1o/’12

12. Vitamin B12; should be ’38 to .50; I’m .45.

13. Hepatitis-C-I don’t have it. Dr Gilbert-8/12.

14.1 Medications: taken every day as of February 2013 effexor;-75/37 and 1/2 alternating mg-in morning beginning May 2015; Feb. 2014: seroquel-50 mg- in evening; duodart for prostate-begun 17/2/’13.

14.2 Vitamins and Minerals: taken every day as of February 2013 A. magnesium-150 mg-in evening B. fish oil-1000 mg(stopped in 2014), vit D-1000 IU(every 2nd day as of 12/'14) multi vit(discontinued in 10/'14), zinc-25 mg, +V, aspirin-100 mg B.-in morning(stopped in 2014)

B. ITEMS TESTED NOT-IN-THE-BLOOD:

Much of the information in this section is now archived and is not required for on-going medical information and visits to doctors.

1.The Prostate: -see blood test results- (ng/ml=nanograms/millilitre)--result-OK as of 5/1/’12--*next FUB—on 13/2/13 with Dr. Monsaur. (PSA 1.3 on 31/10/’12, should be less than 5.9

I will edit the following paragraph when time permits

2.Wax Build-Up In Ears: Use ear drops: cerumol: keep putting in drops once/month, if useful. Don’t use drops from 2009(circa) and following. Syringe dates:10/01, 10/02, 15/03 and 17/03. No syringing: 2003 to 2011. Syringed on: 11/4/’12.(10 drops once a month, 15 minutes laying on bed to get drops into ear-smelly). Had hearing test on 13/12(result?)

3. Chest X-Ray: Result of test in June 2001: diagnosis of chronic obstructive pulmonary disease; elasticity of lungs is less than it should be; need to breath more deeply, more vigorous exercise. Such exercise was begun in May 2003. Stopped in August due to sore foot. Last chest X-Ray: 2004 and 2012. No problems.

October 04-okay: no significant change from 6/01; discuss at 12/05-no need for X-ray; discussed again at visit in 10/06, 12/07 and 1/09. No need to discuss again unless some new problem arises with breathing/lungs. Spirometry test on 19/12/07-3:30 Result: mild asthma: puff-ventalin-prescription-once/day. Got results sheet on 6/3/08. Discussed with Kylie: discussed (a) use of spacer and (b) whether to get ventilin & inhaler. Decided it was not necessary because I was doing the buteyko exercises.

4. Check my moles/warts/sores on scalp/small growths for cancer and to get rid of them if annoying. 2001:Sore on neck was not carcinogenic; small growth on arm not cancer. 3/2002-3/2004-no problems. Wart on forehead: cut off:-3/12/04. pay: $10; stich out on 8/12/04. Discuss growth on arm on 20/1/11 & got script for fixing it. Alternative: (i) buy wort paste, (ii) put clear nail polish around paste, (iii) put waterproof tape around nail polish, (iv) leave for 4/5 days; and (v) then repeat until wort is gone. Dr. Z. will do a nitrogen burn-off on 11/11/’11 at 1:30(done by Dr. Bailey-Smith on 30/6/’11). I said I was prepared to live with the problem of possible satellite warts developing after burn-off. I took off the mole with a band aid on the mole for 1 week-5/1/’12.

5. Complete 'Medical:' 6/1/’13-all okay. Information on 1/10: weight: 230 lbs/105 kg; height: 181 cm; waist 46 ½ inches or 118 cms; blood pressure is always good. All other pressure tests on stomach, chest, feet, back, etc.-OK. Next complete medical on 7/1/14.

6.Check for bone density. Walking, aerobic and non-aerobic, is enough. March 2003: okay. 2/05 Bone density is an indicator of osteoporosis and fracture risk-have a test at age 70. Treadmill exercise 2005-2007. Take Vit D and calcium. 7.1 Sore feet and other podiatry problems began about August 1, 2002. Need to wear pad under foot/inner sole and not stress my foot until it is better. My foot was okay by 6/04. I tried the treadmill beginning in 04/05, but lost the desire. The podiatrist in Launceston I went to was Daniel Lightfoot: 63319568. He suggested 5/05 that: (a) my wife cut my toe nails. He is at 18 Brisbane Street. No more appts were required. See podiatry file. 7.1.1 I got a referral to see Podiatry North(63365155) from Dr Z on 28/6/’12 and I went there and saw a podiatrist in 9/12 and 12/12 for nail-cutting to prevent ingrown toe-nail. The chilblain went away by the summer. I could buy a circulation booster machine because my problem may be simply “skin circulation.” I will get a letter from podiatrist) around 11/5/’13 to see her again. New shoes-no; cream on foot-yes, item from chemist for chilblain-no.(see podiatry file) 7.2 Plantar Fascitis: pain under the heal of foot(see internet info) from 9/7/08. After 6 weeks I bought a heel pad on 26/9/’08 for $40; got a pad from Viv in 8/08. Made list of treatments: ice pad, rest, support, anti-fungal. If more help is needed go to: Int’l Show Store on Bathurst St. for a high density foam pad. Talked to Dr.Z and she said (a) the problem could last for 1 year and (b) keep going for walks. All ok by 12/09.

8. Eucalyptus/tea-tree oil is good for fungus. I have no fungus on 12/12 but signs exist that I have had fungus. Discussed with podiatrist. Have used anti-fungal cream off and on from 10/06, & daily from 8/07 to 10/08. The problem is also due to wetness and age; therefore keep foot dry. I have used eucalyptus oil on both big-toes. Anti-fungal powder is good, buy fungal cream & eucalyptus oil is enough. Soak in vinegar and water every two weeks. Got script for lamasil every day(30/6/11) in toe-nail cracks; got antibiotics for blood due to cutting of toe-nail(30/6/11).

9. crotch itch with cotton balls; wash with hot cloth and dry with small towel. Use ointment(NEAT 3-B action cream) when there is an itch. 10.Breathing: got adenoids out when a child?; buteyko, asthma(ventilin); Fess nasal spray(75 ml) cleaner/lubricator-not necessary. *11.Flu shots: Had a flu shot in 8/07, 6/08 & 4/11. This flu shot should be done annually. The last one was done on 28 March 2012;(next 3/’13) I got a letter. The routine: Take script to chemist; take container from the chemist back to Dr. Z’s receptionist. Dr.Z had no record of my having a flu shot from 1999 to 2007. We decided to have a flu shot annually especially. 11.1 Had a pneumonia shot at age 65 on 28/10/09 & I will have it again at age 70—that is in July 2014. Not required after that. 12. Gave Dr. Z a Donation of My Brain form 12/07. *13. Faecal occult blood test. Got 3 containers on 9/2/09 for faeces for three days(Tu, Th & Sun). Took them to pathology separately and waited for results. Everything is okay. Do this test annually. Last one on 21/5/10. Next one: April 2014. Got kit from Dr. Imran Aslam on 11/4/12)(every 2 years?*) 14. Reflux/gastric-acid in stomach. Check the foods I have eaten and see if there is a relationship between the foods and the acidity, 9/2/09. No relationship noted by 20/2/09. 15. Swelling of knees in 1950 due to virus or scarlet fever; pneumonia 1946-50(2). 16. Stomach cancer-pin-prick test-kit from chemist. Chemist had no kit on 20/2—only in U.K.Dr Dawson said there was no such kit on 12/12. 17. Immunization shots: (a) typhoid: script($44.05-paid-pd)shot 11/3; (b) triple antigen: $37(pd-at Anne St.)-tetanus booster(last one in 2000); next one in 1/’1. This also covers whooping cough & diphtheria; (c) anti-biotics for diahorrhea & vomiting on 9/4 & (d) hepatitis A&B: ($70x3=$210Pd)18/3(11:20),25/3, 9/4/09(twinrix) & 9/4/10(*)(done) Got a letter to cover my medications to take to Israel. Polio booster-$50 & flu shot on 12/3($53.50-pd). Next tetanus-booster in 1/’21.

18. Had a test for benign vertigo. It had gone away by 24-9-09 after 2 or 3 days of this dizziness. I had this same problem several years ago and did a “movement of the finger from side to side test...standing up and sitting down.” 19. Folliculites: got a script for doxy on 15/8/’12(take with food. Hamilton Bath Oil-Dr Gilbert suggested this and Chris got a medicated soap. She also advised I use: (i) Gentle Wash in the shower, and (ii) Skin Lotion after my shower. I have rosacea on my face. I went back on 26/9/’12 and got another script, but Chris thought it better not to take it. Chris bought pHisohex on 12/12/’12 to use in shower. Got another script for Eryc on 13/12 for folliculitis; got pHisohex at chemist on 6/12/’12; I got the script for Eryc on 15/12/’12 from Dr Dawson. I decided in 1/13 not to renew the script. I will now just watch and wait to see how the pimples develop.

20. Keep track of other illnesses/diseases/problems that arise from time to time due to (a) personal experience or (b) things I hear about from people or in the media.

C. OTHER: C.1.1 Dr. Ratcliffe and C.1.2 Brenda Gunst C.1.1 Stopped seeing him in 2009. C.1.2 -28/6/’12-holistic interview and saw her again on 10/8/’12. C.2 Dr Hyde: See my statement on BPD; saw him 4 times from April to August 2012; 63340188; 166 St John Street C.3 Other Medical Information(for use when filling out forms) 1. last hospitalization-May 1980. 2.COPD/emphysema-2001-diagnosed on this date. 3. frequent urination: every 80 minutes as calculated in 8/07. 4. depression: 1963 to 1978-periodically before BPD diagnosed in May 1980. 5. testosterone injections from 9/98 to 2/99. Last Updated On: 17/2/’13.


APPENDIX 5.1

MEDICAL FILES-INDEX

The contents of this list are kept in 3 clip-boards entitled: Volume 1, Volume 2, and Volume 3. All this information is kept in my computer directory under: DIARY>medical-bipolar>current index-outside.doc.

TABLE OF CONTENTS

A. List of doctors' appointments: 2014-15

VOLUME 1

1. Dr Jane Zimmerman GP
2. Dr Barry Gilbert GP
3. COPD: See Dr R Raj:renal physician
4. Dr Michael Monsour: Urological Surgeon
5.1 Lindsay and Bojoura: Podiatrists
5.2 Optomotrists(in brown brief-case)

VOLUME 2

6. Dr Rajesh Raj:Renal Physician or Nephrologist
6.1 Blood Pressure Results
6.2 National Kidney Foundation USA
7. Dr. George Hyde: Psychiatrist 7.1 Gastroenterologist

VOLUME 3

8. Blood Test Results: (a) Pathology Serv. L’ton & (b) GT pathology 8.1 Cholesterol
9. Chris Price’s Medical Information-See also Section E-Brief Case
10. Dentist 10.1 Personally Control Health Record System(PCHR)

APPENDIX 5.2

CHRIS’S MEDICAL INFORMATION SHEET

This file is divided into sections A & B

A.CHRIS’S MEDICAL INFORMATION FILE

Preamble

This file was opened when Chris went to Hobart to see Dr Helen Cooley a rheumatologist on 10 October 2012. It was up-dated after she saw Dr Burger, an endocrinologist, in Melbourne in February 2014. This file is updated whenever: (i) she visits a doctor, and (ii) Chris and I review her symptoms, the most recent occasion was on: 14/3/'15. Due to the complexity of her health issues it became useful for me to open this file. Beginning on 12 July 2012, exactly 41 years after I arrived in Australia, I made some notes after Chris saw her Launceston GP, Dr Manifold. This was the start of my keeping of this file. This file is located in my computer directory at: Diary>Everyday>CHRIS Health.

A. The following is an updated statement to: 14/3/’15:

A.1 Neck and Shoulders:

(i) Chris has compressed discs in her neck and 2 torn ligaments since 8/2012. Such ligaments do not repair themselves in older people. (ii) She has arthritic neck and hands, that is, arthritis; her hands are actually osteo-arthritic; her neck has arthritic spurs and she has a torn rotator cuff in her shoulder. She also has an inflammatory problem; perhaps her anti-inflammatory medication, brufen, is helping; she got relief from a steroid injection in August 2012. Her shoulder has momentary problems and, sometimes, after some work in the garden, she has a delayed reaction with shoulder and/or neck discomfort lasting sometimes for 2 or 3 days. Brufen/neurofen is taken every day at 400 mgs. (iii) She rubs voltaren in as needed. This is an anti-inflammatory ointment which reduces the inflammation in the body that causes the pain in her neck and shoulders. She started fish oil again on 15/7/'14, but only took it for a short time. Chris sees no alternative to her muscle problems. Chris had a muscle biopsy in Hobart(circa 2012) and she sees her muscle-problems as undiagnosed. (iv) In the weeks of 15/12/'14 to 27/12/'14 Chris got the flu and chest-cough. She had pain across her shoulders and down her right and left sides-arms. She also has an exacerbating muscle-problem, an inflamation, which she does not understand. She plays with, manages, her thyroxin(T) levels(100 mcgs on 2 days in a row) to see if she can optimize the effects. If she takes too little T her mood is low.

A.2 MCKD

She may have MCKD-phase 1(moderate chronic kidney disease); it has improved since she stopped taking vitamins. Her creatine level is monitored by her GP once/year.

A.3 Rheumatologist for Fibromyalgia

Chris went to Hobart on 10/10/’12 to see a rheumatologist and got a diagnosis of fibro-myalgia. But Chris only partly agrees. she sees her fibromyalgia as a mild case at best. Her inflammatory problem is an auto-immune attack; it is seen in her red nose and red face occasionally.(28/6/'14).

A.4 Hypothyriodism

A.4.1 Chris is managing her hypothyroidism; to put this another way: her hypothyroidism is corrected. Her anti-nuclear anti-bodies are high, and this causes "flare-ups", auto-immune attacks. But she does not want to take pregnisolone. Her ANAs(anti-nuclear anti-bodies) and anti ds-NDAs are slightly high. Her GP, Dr Maxine Manifold ignores this, says Chris, and prescribes brufen. Chris sees these ANAs, these blood indicators, as a sign of "a little lupus." She did not like the lupus group(circa 2004). A.4.2 Chris is now on a slightly reduced thyroxine regime after seeing both her endocrinologist in 2/14, and her GP. On this regime she is trying to balance, to achieve, maximum muscle competence and lowest anxiety levels. If she takes more thyroxine(.7 micrograms/day) she is happier with only slight anxiety, more inner well-being and more energy; if she takes less she has less anxiety but also less well-being and energy.(see her thyroxine systems on the attachment, and p.2.2.3) A.4.3 Chris gets her BP checked and her blood-sugar levels as well. She had her 2nd ultra-sound/scan on 27/1/'15; the last one was in 2013(circa) and she was ready to have an operation on her hernia when it was cancelled at the last minute. This scan also examines musculature and fat lumps.

A.5 Medications:

Medications taken daily: (i) brufen-400 mg in am after some food(if she misses her brufen, then there is a problem--see below under A.7) (ii) catapres-25 mg to prevent headaches by lowering her blood pressure, (iii) thyroxine(T)-100 to 75 micrograms for thyroid replacement. Chris changes the 100 mg and 75 mg doses from day to day to aim for an optimum state of day-to-day comfort. T presents a management problem. There is a fine line between too much and too little T. If Chris takes too much she is: irritable and anxious; too little she is irritable and lethargic and lacking in energy. Chris gave me a 4-page-package on thyroxine on 28/1/'15 after doing some internet Googling. This info is kept in this file on pages 8.1 to 8.5.(See: Dr Anthony Toft's article "Understanding Thyroid Disorders") (iv) maxilon>aspirin for migrane headaches as advised by her neurologist and GP. This helps the inflammation; licorice diet.

A.5.1 Headaches & Nausea

From time to time Chris gets a bad headache, sometimes a migrane, and an accompanying nausea. It lasts for 3 days at the most; she often continues her social/family/responsibilities and physical activity. There is no tweeking of the thyroxine which has usually been tweeked in the days before the headache.

A.6 Loneliness, Alienation and Sleep

A.6.1 Alienation and loneliness are ongoing problems; see pages 2 and 3 in this file for a relevant context. Sleep: 2 hours, then 4 and then 2(with the radio) A.6.2 Beginning in February Chris has had no "sparky" days. In our discussion of this subject on 14/3/'15 she thinks this is, in part, due to all family members being 'a problem for her' in some way or another. This makes her feel down and anxious.

A.7 Visits to Dr Manifold

A.7.1 On 20/11/'14 Dr M gave Chris an electrocardiogram; she last had one when an ambulance came to the house in early 2013(circa). Dr M worries about Chris's heart, and possible heart failure due to her taking thyroxine(T). Chris thinks Dr M does not need to worry about her heart since, when she takes T, she always breathes more easily and struggles with life less. Chris wanted Dr M to check her ANAs & her rheumation problem when she visited her on 13/1/'15, but Dr M did not want to. Chris felt badly because Dr M was concerned that Chris was outside the thyroic range. A.7.2 Dr M ignores the inflammation factor, but has prescribed brufen(a non-steroidal anti-inflammatory medication)(Temponi prescribed pregnisalone-a steroidal anti-inflammatory med'n) Chris's Care Plan: is discussed with Dr Manifold every 3 months. A.7.3 Chris and I had a series of chats on 17/1/'15 because she was feeling very bad. We concluded that she felt so bad for a range of reasons: forgot the brufen, had a cold, Maxine's emph on 'outside-the-range', Social-psych(mother-Ange, Viv-Zu, me), etc. A.7.4 Chris and I had a series of chats from 26/1/'15 to 28/1/'15 after she changed from her standard thyroxin schedule of: 100, 100 to 100, 75. The result was: struggle. C thinks: (i) if she persists for 6 weeks(as Dr M thinks is best), then maybe she will be OK; and can C actually put-up with the discomfort for that long?, (ii) the thyroid gland may 'kick-in' after 6 weeks with extra thyroxin, (iii) maybe taking too much thyroxine/the supplement, as she is doing, she is turning-off the thyroid gland(Question: is the thyroid gland capable of being turned-off?), and (iv) her TSH is very low. A.7.4.1 Some of Chris's symptoms include: a slow husky voice with a bit of slurring of speech, a rough and dry skin, a purplish-flush in her cheeks, dry and brittle hair, a dodgy balance, and constipation. A.7.5 Chris also went to the optometrist and needs new glasses. She went to see Dr M from in 2013 to January 2015 several times. On 13/1/'15 Dr M advised Chris to get an ultra-sound for her hernia and a bone density scan.

A.8 Carer's Allowance:

A.8.1 I thought it would be appropriate to add a note on the condition of my wife's health in relation to my receiving a Carer's Allowance. Since we live together under the same roof, so to speak, the health of each of us impinges on the health of the other. I have often thought it would be logical to apply for a Carer's Payment and/or a Carer's Allowance since my wife has not been well for many years. But, thus far I have decided not to do so. The general details of my wife's condition are outlined in the above and the following statement which I initially thought of putting together when Chris was under the care of Dr. Joe Tampone at the Summerdale Medical Centre on Stanley Street 63447177 in 2004. A.8.2 Chris has a Carer's role in relation to me and I have a Carer's role in relation to her. This is an overall part of the picture of my personal and private situation and it was certainly relevant to include in my statement of application for the continuance of the Disability Support Pension back in 2004(circa). Living with a person with BPD is a separate problem.

A.9 Digestive Problems:

irritating foods in the gut. The cause is gastritis>inflammation.

A.10.1 MedicinePlus, and A.10.2 The National Institute of Health: See Section B(pages 6 to 18).

A.11 Thyroxine Chart:

________________________________________________________ 100 100 75 100 75 100 75 (625 over 7 days)(89.3 mcg/day)(35 days, 90 mcg/day) (difference is 0.7 mcg/day) ------------------------------------------------------------------------------- 100 100 75 100 75 100 100 75 100 75 100 75 100 75.. .............14 day cycle....... 75 100 100 75 100 75 100 100 75 100 75 100 100 75 100 75 100 100 75 100 75

General:

1. Thursday and Friday are Chris's best days; on Fridays she is at the top of her cycle and on Wednesdays she is at the bottom. 2. Chris tried alternating for 3 weeks in Feb/March 2015; the result was that her 'mood stamina and sense of well-being' dropped. Updated on: 14/3/’15. ------------------------- B.The Following is a Summary of Section B(pages 8 to 25)

1. Pages 8.1 to 8.5: thyroid and thyroxin 2. This is Section B(A.10) With: (a).... 1. Notes from Medicine Plus: A Service of US National Medicine and the National Institute of Health 2. Personal Notes on 3 general problems which Chris has: 2.1. dealing with my BPD; 2.2 feeling a little crazy a lot of the time, and 2.3 feeling she has done the wrong thing and has no right to her opinions. she handles these issues if she has more thyroxine. (b).1 Living with chronic illness (b).2 Talk with People Who Have the Same Illness (b).3 Tell others about your chronic illness Note: Chris saw Lib Hayword in 2010, a psychologist. (c).Time Frames: 5 years with Helen Cooley-rheumatologist(2007-2012); 2 years with Temponi(2003-4) to get rid of stomach worm/problems-Katherine(1983-2003); gastritis disappeared in 2014. (d) Page 19 has (i) information from problems Chris has when she goes on trips and (ii) after-effects of hysterectomy (e) Page 21 has 23 symptoms on an X-Y graph (f) Pages 22 to 25 info about fybromyalgia ------------------------------------------------------------------------------- -Updated on 14/3/'15.

APPENDIX 5.3

DR BARRY GILBERT

2012 to 2015

A.1 We discussed getting a referral on 26/9/12 for me to see the Renal Physician, Dr Raj Rajesh. He faxed through to Dr Rajesh’s rooms and I saw Dr R.R. on 16/10/’12 for the first time at 3:00 pm. $200 up-front and $125.90 back from Medicare(I gave Mandy my bank details)-63344188 at St. Luke’s, 16 Lyttleton St in L’ton. I renewed the referral on 3/9/’13. It needs renewing on 3/9/'14 to 3/9/'15.

A.2 Dr Gilbert took my blood pressure on 3/9/'13 which was 126/64 and my pulse was 69. He thinks these good results were due to the new blood pressure pills: ramipril which I began taking at the end of August 2013. I also got copies of the blood test results from Dr R.R., and we discussed them briefly. We discussed the blood-tests I will have on 6 November 2014 and removed Vit D and B12. Next appointment with Dr G is on 16/5/'14; next one is: 13/11/'14 at 3 pm. See the Dr R.R file for more details.

B. We discussed my visit to Dr G Hyde in January 2014. I gave him the feedback to send to Dr Hyde regarding the reduction in seroquel from 75 to 50 mgs and the fact that I: (a) was in bed and asleep the same amount(12 hours for 8 to 9 hours sleep), and (b) had more energy during the day. See the Dr Hyde file for more details. We discussed reducing seroquel to 25 mg after seeing Dr Hyde. I got letters from 3 specialists in March 2014.

C. We discussed the Dr M Monsaur option of rebore vs "watchful waiting" for my enlarged prostate. See the Dr M Monsour file for more details; last visit 15/5/'15 and next one 14/5/'15(noon)

D. On 13/12/’12 I discussed the results of an audiogram, a hearing test. I had a 2nd hearing test on 3/4/’13, a 3rd on 3/9/’13, and a 4th on 26/3/'14 at 10 a.m. Result: I have a high frequency hearing loss in my left ear; my right ear is normal; I do not have an acoustic neuroma and Dr Gilbert gave me a 2-page hard-copy description. He and I decided that an MRI scan was not necessary. My hearing in the right ear, as I say, is fine, in fact, it was better on 3/9/’13 than it was on 3/4/’13. My left ear does not have ‘progressive hearing loss’; it has ‘impaired hearing loss'. I will have a hearing test and a spirometry test annually.

E. Got a script for lubricating eye drops known as ‘artificial tears’ on 3.9.’13. Chris finds these drops useful as well and we will get the script filled bu 7/9/’13.

F. Dr Gilbert examined my folliculites in the winter of 2012 and, by the winter of 2013, it had cleared-up. It came back on my arm in January 2014. I used phisohex and it had cleared-up by 4/3/'14 when I saw Dr Gilbert again.

G. We discussed ‘the free-radical theory of aging’ and decided there was nothing I could do, although drinking water was useful. We discussed hemochromatosis or iron overload in the body. There is no evidence I have this as a result of blood tests in 2012/13. F. Heartburn is a problem if it arises more than 3 times/week. As of 3/9/’13 I do not have this problem. I did not discuss this with Dr Gilbert, but I’ve put this potential problem in his ballpark, so to speak. We discussed eHealth, but Dr Gilbert does not use that system as yet. I do not have hepatitis C as of 8/12/'13.

H. No need for a ECG; pulse and BP is sufficient. Got a pneumonia shot on 24/4/'14, and faecal blood kit; discuss results on 16/5/'14.

I. 1. warts in 2013. See Barry in 2014 for any more to be removed. 2.After reading about the side-effects(SE) of the several medications I take, and listing the SE that I am experiencing, I discussed the fatiging effects of the following with Dr Stacey on 9/12/’13 &, again, with Dr.Gilbert on 16/5/'14.

J.1 Medications:

1.rosuvastatin: weakness, symptoms may appear from 1 day to years.
2. duodart: (uncommon) weakness, loss of strength, light-headedness, retrograde ejaculation
3. Effexor: tiredness, sleepiness,, general tiredness, weakness, indigestion, lethargy, weight gain
4. Seroquel: drowsiness, tiredness, weight gain
5. metformin: for diabetes 2
Note: Seroquel causes my fatigue until morning, and the effexor has a significant contributing effect to that fatigue during the day.

J.2 On 16/5/'15 we: (i) discussed wax-no problem, (ii) watchful wait for enlarged prostate and taking duodart after a rebore to keep libido low; (iii) fecel occult bood count and colonoscopy: I had "a day procedure" on 1/10/'14 which included: (a) anesthetic, (b) a picoprep drink, (c) dealing with the cause of bleeding(inflamed bowels or polyps), (d) Chris to pick me up, (e) gastroenterologist performed the op, (f) stop taking aspirin; and (iv) forgot to get 2 referrals for Dr R and Dr M.

J.3 Rosuvastatin is one of the most commonly prescribed medications for cholesterol reduction.

A Risk Management Plan is a document that a person like myself can prepare to foresee risks, estimate impacts, and define responses to issues. It also contains a risk assessment matrix. A risk is "an uncertain event or condition that, if it occurs, has a positive or negative effect on a project's objectives." Risk is inherent with any project, and people like myself should assess risks continually and develop plans to address them. The risk management plan contains an analysis of likely risks with both high and low impact, as well as mitigation strategies to help the person avoid being derailed should common problems arise. Risk management plans should be periodically reviewed by the project team to avoid having the analysis become stale and not reflective of actual potential project risks.

K. Future appointment schedule: (i) after the colonoscopy on 1/10/'14, & (ii) then again on 13/11/'14 at 3 pm to discuss the results of the blood tests on 6/11/'14.

Updated on: 6/10/’14.

APPENDIX 6:

THE STIGMA OF SILENCE: AN ARTICLE BY GLENN CLOSE

The following comments come from an article entitled: Mental Illness: The Stigma of Silence by Glenn Close(October 25, 2009, The Huffington Post) I have slightly edited the following post at the website: www.huffingtonpost.com.--Ron Price, Tasmania

1. Glenn Close is an Emmy, Golden Globe and Tony Award winning actress. This is her book and to her mental illness was no stranger. She writes that from Alex Forrest in Fatal Attraction to Blanche Dubois in A Streetcar Named Desire, to Norma Desmond in Andrew Lloyd Weber's Sunset Boulevard she had the challenge and the privilege of playing characters who have deep psychological wounds. Some people think that, in these movies, Alex was a borderline personality and that Blanche suffered from post-traumatic stress disorder. Everyone knows that Norma is delusional.

2. Glenn writes that she had the challenge of confronting the far less entertaining reality of mental illness or mental distress in her own family. Her sister suffered from bipolar disorder and her nephew from schizoaffective disorder. There has also been a lot of depression and alcoholism in her family. Traditionally, she says, no one ever spoke about these problems. It just wasn't done. The stigma was and still is toxic Close emphasizes. Like millions of others who live with mental illness or mental distress in their families she has seen what these people have to endure. It is often the struggle of just getting through the day. It is also the hurt caused every time someone casually describes someone as "crazy," "nuts," or "psycho".

3. Even as the medicine and therapy for mental health disorders have made remarkable progress, the ancient social stigma in relation to psychological illness remains largely intact. Families are loath to talk about it and, in movies and the media, stereotypes about the mentally ill still reign. Whether it is Norman Bates in Psycho, Jack Torrance in The Shining, or Kathy Bates' portrayal of Annie Wilkes in Misery, scriptwriters invariably tell us that the mentally ill are dangerous threats who must be contained, if not destroyed. It makes for thrilling entertainment. There are some notable exceptions, of course -- Dustin Hoffman in Rainman, or Russell Crowe's portrayal of John Nash in A Beautiful Mind. But, more often than not, the movie or TV version of someone suffering from a mental disorder is a sociopath who must be stopped.

4. Alex Forrest is considered by most people to be evil incarnate. People still come up to Close saying how much this character terrified them. Yet in her research into her own behavior, she only ended up empathizing with this character. She was a human being in great psychological pain who definitely needed meds. She consulted with several psychiatrists to better understand the "whys" of what she did and learned that she was far more dangerous to herself than to others. The original ending of Fatal Attraction actually had Alex commit suicide. But that didn't "test" well. Alex had terrified the audiences and they wanted her punished for it. A tortured and self-destructive Alex was too upsetting. She had to be blown away. So, the director and producer went back and shot the now famous bathroom scene. A knife was put into Alex's hand, making her a dangerous psychopath. When the wife shot her in self-defence, the audience was given catharsis through bloodshed, Alex's blood. And everyone felt safe again. The ending worked. It was thrilling and the movie was a big hit. But it sent a misleading message about the reality of mental illness/distress.

5. It is an odd paradox that a society, which can now speak openly and unabashedly about topics that were once unspeakable, still remains largely silent when it comes to mental illness/distress. Breast cancer and even Aids engage political and health care leaders from every part of the globe. Illnesses that were once discussed only in hushed tones are now part of healthy conversation and activism. Yet when it comes to bipolar disorder, post-traumatic stress, schizophrenia or depression, an uncharacteristic coyness takes over. People often say nothing. The mentally-ill seem to frighten and embarrass the general population. The mentally-ill are marginalized by the people who most need their acceptance.

5.1 What mental health needs is more sunlight, more candour, more unashamed conversation about illnesses that affect not only individuals, but their families as well. Our society ought to understand that many people with mental illness/distress, given the right treatment, can be full participants in our society. Anyone who doubts it ought to listen to Kay Redfield Jamison, a psychiatry professor at Johns Hopkins, vividly describe her own battles with bipolar disorder.

6. Over the last year, Close has worked with some visionary groups to start BringChange2Mind.org, an organization that strives to inspire people to start talking openly about mental illness/distress, to break through the silence and fear. That group has the support of every major American mental health organization and numerous others. Close has no illusions that such an organization will serve as “a cure” for mental illness/distress. Yet she is sure it will help society along the road to understanding and constructive dialogue. It will help deconstruct and eliminate stigma.

7. The World Health Organization estimates that by the year 2020 mental illness and its distressing symptoms will be the second leading cause of death and disability. Every society will have to confront the issue. The question is, will society face it with open honesty or silence, with a slow and gradual destigmatization process as has happened over the last two decades or a faster one in the next decades, say to 2044, when I will be 100 years old.

APPENDIX 7:

THE DAVINCI METHOD

1. The following email and comment was received in two parts from Garret LoPorto, the author of The DaVinci Method, on Friday 13 November 2009 and 5 February 2010, respectively. He wrote the first part of this message, as he said, inspired by Pearl Buck 's poetry. While the sentiments in his email below are a little over-the-top as they say Downunder, there is a core of truth in the tone and texture of what LoPorto has written. LoPorto sent this email to a very wide range of people, some BPD sufferers and some not. I include parts of these emails in this appendix to my story for its value in conveying some of the core experience of those who suffer from BPD.

2. The BPD gene, so the argument goes, affects the brain's relationship with dopamine. This difference causes one to crave stimulation just to feel alive and makes one's moods unstable. The key to success when one has BPD is learning how to channel all that creative energy into taking intelligent risks. People with BPD are brilliant as well as not-so-brilliant risk takers. LoPorto states that 10% of the world has a special temperament, what he calls the Da Vinci temperament. The Da Vinci temperament has very low self-repression. This sensation-seeking temperament is shared by virtually all great visionaries, pioneers, entrepreneurs, artists and innovators. All of the impulses and creativity that the subconscious mind generates come to surface in the conscious mind and have to be dealt with. Hypomania is actually a very powerful asset that has helped some of the world's most successful people achieve their success. In retrospect I feel it has helped me over the decades. Hypomania allows one to solve difficult problems easily and it maximizes the energy available for the task at hand. It is a condition similar to mania but less severe.

3. The symptoms are similar with elevated mood, increased activity, decreased need for sleep, grandiosity, racing thoughts, and the like. However, hypomanic episodes differ in that they do not cause significant distress or impair one's work, family or social life in an obvious way while manic episodes do. Hypomanic people tend to be unusually cheerful, have more than ample energy and need little sleep. Hypomania is a pleasurable state. It may confer a heightened sense of creativity and power. However, hypomania can subtly impair a person's judgment. Too much confidence can conceal the consequences of decisions. Hypomania can be difficult to diagnose because it may masquerade as mere happiness. Hypomania is a feature of three mood disorders: bipolar I, bipolar II disorder and cyclothymia, but it can also occur in schizoaffective disorder(SAD). I was diagnosed as having a mild SAD in the last months of 1968 while I was institutionalized in a large psychiatric hospital in Whitby Ontario. Whatever hypomania I had at that time, if indeed I had any, it affected my productivity.

4. People with BPD have a keen sense of intuition and the states of their minds are extreme. They are prone to experiencing periods of tormenting confusion followed by moments of great clarity. When the clarity comes in it brings with it bursts of creative genius and a spontaneous awareness of exquisite solutions to problems that previously seemed insurmountable. The only way a person with this disorder gets to have that amazing insight, that paradigm shift of thought, that out-of-the-box solution is to engage in one’s project and encounter the frustrating complexities of one’s current approach to achieving its goals.

5. As LoPorto says “Oprah Winfrey's grandmother gave this disorder, this temperament, this gift, to her. She has never forgotten it and says it probably saved her life. Sir Richard Branson's mom gave it to him and it has propelled him to amazing heights. Thomas Edison's mother gave him this gift, too, and he said it was the making of him.” This gift used to be very rare, difficult to give and nearly impossible to talk about because people simply didn't have any way of saying what it was. Now people do.

6. Dear Ron,

You are amazing. Many do not understand your bipolar nature but you can rest assured that the bipolar experience is no more than this: a heroic soul born inhumanely sensitive, desperately in need of true connection. To you---a touch is a blow, a misfortune is a tragedy, a joy is an ecstasy, a friend is a lover, a daydream is a premonition, strictness is suffocation, and completion is death. Added to your brutally sensitive soul is the overwhelming need to heal, create, and transform. Without the outpouring of honesty, the creating of music or poetry or something of meaning your very breath is cut off.

You must create, must pour out your entire being in each and every encounter. By some strange, unknown, inward urgency you do not feel truly alive unless you are risking everything through your divine expression. Thank you for having the courage to create, to transform, to be in a way other souls don't. For without your courage and your light the world would grow listless and dull and the rest of us who are like you would not have your courageous acts to inspire our own.

Rock on,
Garret LoPorto
Author of The DaVinci Method
www.DaVinciMethod.com

7. LoPorto sent the follow circularized message to me on 5 February 2010:

There are ideas, beliefs and habits that spread from mind to mind, installing and running themselves in your thought process without your permission. They can: (a)hijack your mind and your life and rob you of your dreams and your freedom? (b) silently upset, hurt and cause you, in turn, to hurt your loved ones? (c) make you think in ways which are unnatural and depressing? (d) cause massive frustration and unnecessary failure in your life? and (e) these viruses are the root causes of ADHD, BPD, compulsions and obsessions as well as addictions and depression. LoPorto deals with these ideas. So must I in my life and this BPD story will continue to tell of my successes and failures in this part of my life-narrative.

APPENDIX 8:

MEDICAL INFORMATION FILES: FOR RON PRICE TABLE OF CONTENTS

Preamble:

These 5 files assumed the form they now have(1/1/’11) by stages in the years 1999 to 2010, the first decade of my retirement from FT(1999), PT(2003) and casual/volunteer work(2005). I have included this table of content for these 5 files to provide a wider perspective on my BPD. These files are now labelled: Sections: A, B, C, D and E for convenience of storage and retrieval. They are kept in my brown brief-case in my study under my desk to the right. This brief-case is given the single label: Medical Files. Sections A and B are in a single 'fold-over file;’ sections C, D and E are in separate A-3 files. In my computer directory go to: everyday>bipolar>medical>CONT MEDFILE-A-E.

Additional files with medical information are kept for: (a) the mental illness forums I post at and interact with others, (b) mental health information and (c) general health issues. These additional files are found in separate arch-lever and 2 ring binder files on the book shelves and on the floor in my study here in George Town Tasmania.-Ron Price, 1/1/’11.

Section A:

1. Funerals and Burials Info
2. Bi-Polar Illness(now in Section D.1 to D.11)
3. Visits to doctors: Info
4. COPD: Chronic Obscructive Pulmonary Disease
5. Cholesterol Problems & Triglycerides

Section B(i)

6.1 Anne Street Clinic Information
6.2 Prostate Cancer Information 6.2.1 urination

Section B(ii)

7. Cancer: General 7.1 Stomach 7.2 Colon/Bowel Cancer
8. Chris Price
      8.1 Breast Cancer 8.1.1 Chris’ Symptoms
      8.2 Advice from Chris for My Health

Section C:

9.1 Brain Donation
9.2 Organ Donation
10. Male Menopause
11. Medical Cards
      11.4 Medicare Information
12. Bidet Toilet Seats
13. Seniors Card
14. Dentist Information
15. Disability: Definitions/Info/Transport Access Sticker
16. Real Age       17. Diabetes 18. BMI(Body-Mass Index)
19. Foot Problems

Section D: Bipolar Disorder:

1. Lithium
2.1 BPD Genetic Project 2.2 Luvox
3. Sodium Valproate
3.1 Venlafaxine(effexor)
3.2 Neurotransmitters
4. Bipolardisorder
4.1 General Information
4.2 My Statement: 33,000 words(10/’09)
4.3 BPD Research
5. Dr. Eric Ratcliffe: Psychiatrist
      -Consultation Info and Kidney Function
6. Dr. Jane Zimmerman-GP 6.1 medical letter for overseas
7. Other Experts
7.1 Dr. Ayling & 7.2 Alternativies
8. Dr. Christine Price
9. Blood Test Results: Archive(2000-2005)
10. Creatinine Info.
11. Spirometry Tests/Info

Section E: Self-Maintenance-Medical File

1.1 and 1.2…Bi-Polar Story: In 2/08: two copies
2. Blood Test Results: (a) archival(2005-2008)
& (b) current: eGFR & spirometry/urology/kidneys(2005—8)
3.1 Buteyko Information 3.2 Breathing
4. Current Medical Information
-Sheet Number 7
5. Script for Asthma: cancelled 1/08
6. Giving Blood: Red Cross Info 6.1 Blood Pressure
7. Exercise Program Sheets
7.1 Sleeping Record       7.2 Benign Vertigo
8. Special Prayer Package
9. Self-Maintenance File(1)

APPENDIX 9:

SOME RELEVANT POEMS:

1.                                             A STRONG CONSITUTION?

This afternoon, in mid-summer here in Tasmania, I sat under a tree near the beach at Low Head on Bass Strait and read Roy Campbell: A Critical Biography by Peter Alexander.(1982). This South African poet(1901-1957) had, according to Alexander, a magnificent constitution. According to the famous psychiatrist, Laurens van der Post, Campbell was a man "born on fire." He could only live by burning himself out: drinking much and eating and sleeping little. It is difficult, it seems to me, to determine what, in fact, is a 'magnificent constitution.' Have my history of manic-depression, or bipolar disorder, the slow development of a mild emphysema, a certain psychological fatigue as I came into my sixties and, perhaps, several other illnesses like pneumonia and some polio-like disease contracted in my childhood, had the effect of weakening my constitution? Is writing millions of words a sign of a strong constitution? I don't know, but I do know I have experienced varying degrees of burn-out several times in my life. It would appear that, like Campbell, burning myself out was part of my central life experience, although the causes of the burn-out were quite different. It would appear that, in this the early evening of my life, I have learned to live without burn-out and its tragic consequences. -Ron Price, Pioneering Over Four Epochs, 22/1/'02 to 26/8/'14.

Burnout is a psychological term that refers to long-term exhaustion and diminished interest in work. Burnout has been assumed to result from chronic occupational stress, for example, work overload. However, there is growing evidence that its etiology is multi-factorial in nature, with dispositional factors playing an important role. As far as I am concerned now, as I look back over my working life, burn-out was either part of my BPD or, in 1999, it was occupational burnout or job burnout. This latter burnout was characterized by exhaustion, lack of enthusiasm and motivation, feeling 'drained', and it also had the dimension of frustration and/or negative emotions and cynical behaviour, and as a result reduced professional efficacy within the workplace. More accurately defined, "Burnout is a state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress". My exhaustion refered to the depletion or draining of emotional resources, from which cynicism stemmed. Cynicism refers to the indifference or distant attitude of work, and reduced professional efficacy refers to the lack of satisfaction with past/present expectations. In the last months of my paid employment in 1999 I was taking shots of testosterone so that I would not have to go to sleep in the afternoon and would have the energy to get through the day.

A million impressions,
impressed themselves
over these several epochs
in the last half-century,1
pressed themselves upon me
and, as Keats said,2
annihilated me.3

I surrendered, lost myself
to these poetic acts
of creation, acts of love4
where I imagine myself intensely,
merging with the great sea of life
beyond the me and becoming one:
mystic, seer, poet.

1 1952-2002
2 Keats, Letters, 27 October 1818
3 Looking back it would appear that at least 3 reconstructions of personality were required: 1968, 1979/80 and 1999; inevitably there were some continuities, one of which was poetry in 1999.
4 The World of Poetry, p. 92.

Ron Price
22/1/'02 to 26/8/'14.

2. THE FIRE GOING OUT

Bahá'ís believe they are taking part in the career of the growth of a world civilization. As Toynbee points out and as human experience thusfar suggests, the exercise is a dangerous one. Toynbee argues that the danger is constant and acute “because it lies in the very nature of the course which a growing civilization is constrained to take.”1 -Ron Price with thanks to 1Arnold Toynbee, A Study of History, Vol.4, Oxford UP, 1962(1939), p.122.

Toynbee goes on to say that certain “creative personalities who set a civilization in motion and carry it forward” feel the need to carry their fellows with them or “to make a movement out of something which is a halt.”2 This tour de force requires strenuous communion and intimate intercourse to impart the divine fire from one soul to another. There is an inward spiritual grace through which the unillumined soul is fired. But the firing takes place through the principle of mimesis and the process is essentially precarious unless it is crystallized in the form of habit or custom.-Ron Price with thanks to Henri Bergson, The Two Sources of Morality and Religion, Alcan, 1932, p.251.

You said it Arnold,
as you so often do
buried in volumes
of your endless pages of
you’re A Study of History.

It’s a dangerous exercise
for the individual too, Arnold,
one continually revealed by
abnormal changes and chances,
accidents of life like shipwrecks
and fires I have observed for half
a century in the lives of others
and my own dear self: there’s
often demoralization of an inner
man and heroism--difficult to admit
and even define phenomena in our age--
often subtle, with initiative lost,
a kind of burn-out, a kind of salt
losing its savour, a flagging of the
Promethean elan, the fire going out.

Ron Price
June 6th 2006

3. SETTLING DOWN

Ginsberg’s autobiographical poetry, his Collected Works: 1947-1980, gives a shape to his life. There is a sense here of theatre, of playing to the crowd, of the location of the self in place and time. There are many anatomies of loneliness. There are our embarrassments at his self-revelations. From drugs to Buddhist meditation, Ginsberg gives us themes which are now somewhat passe; surface superficialities with little depth; philosophy with hardly any detail, growth or complexity. This bardic-comic-poet gives us formlessness and over-simplification, ugliness and coarseness, the impolite and the imprecise, but he also serves up an incredible energy from a vortex of power. -Ron Price with thanks to Marjorie Perloff, Essays on Modernist and Postmodernist Lyric, Northwestern UP, Evanston, Illinois, 1990, pp. 199-230.

Price’s autobiographical poetry, his Unpublished Works: 1992-2002, give a shape to his life that is not available in his other autobiographical genres. There is a sense of history and of the future, of locating himself and his Faith in the moving flow of history, of time. There are, too, a multitude of anatomies here: anatomies of his poetry, his self, his religion, his times and past times. He rarely embarrasses his readers with awkward self-revelations. His Faith seems just about always at the vortex, at the centre, or the periphery, for he has a passion for conveying its story. There is a sense, too, of new beginnings whose roots are in the past and whose branches are in a utopian world which looks increasingly like a world of realism with a recipe for our survival. -Ron Price, Pioneering Over Four Epochs, 2002.

I saw my own mind destroyed, temporarily,
by some frazzling chemical dysfunction,
burnt-out after jogging
through suburban streets at dawn,
as suggested by Jimmy Fixx
and friends concerned with my health.
I’d asked the House for prayers
and, although answers usually came slowly in life,
this one popped out of the answer box with haste.

Then, I settled down to an ease I’d never known
and only quiet burn-outs:
just the slow, quiet, laid-back reduction of high spirits,
excited enthusiasm and intensities
to memorable and meticulously chosen words,
observing the melancholy outlook and the propitious events
leading our world community to influence the processes
towards the Lesser Peace
and helping our concentrated endeavour
and the magnificent progress
of the projects on Mount Carmel.

Ron Price
1st edition : 1 June 2002
12th edition: 21 November 2012

APPENDIX 10: BIPOLAR DISORDER AND THE ELDERLY--THOSE OVER 65

1. Peak prevalence for bipolar disorders in the community is 1.5% and it occurs in late adolescence and young adulthood. That was certainly the case with me. It is dramatically lower among community-dwelling elderly people, that is, less than 0.1%. A typical general practice like the one I am going to now in a city of some 100,000 in Tasmania Australia, at the age of 69. might include only a few elderly bipolar patients whose effect on the practice is disproportionate to their numbers. In contrast, reports from geriatric inpatient units describe a treated prevalence of approximately 10% for bipolar disorders.

This is in comparison to rates of 0.4% for those aged 45-64 years and 1.4% for those aged 18-44. Perhaps young bipolar patients "burn out" after many years of illness and so are not found in the community among the elderly. By and large, clinical presentation of bipolar disorders in old age is similar to that in younger adults. Symptoms appear to be less intense, although there is a high prevalence of cognitive dysfunction in the elderly. Geriatric BPD is not uncommon; however, its phenomenology, course, and treatment are "grossly understudied."

2. Nearly 25% of veterans being treated with bipolar disorder and 9.2% of patients with bipolar disorder in one population study are over the age of 60. Needless to say, even if these percentages remain constant, the absolute number of elderly patients with BPD will continue to increase as the number of Americans over 65 years of age grows during the next few decades. On the basis of current estimates, the number of Americans over the age of 65 with a psychiatric illness is expected to more than double, from the approximately 7 million currently to a projected total of 15 million by 2030.

3. It is also important to mention that one can further subdivide the geriatric BPD patient population into 2 subsets of patients: those with early-onset BPD who have had the disease since childhood or young adulthood, and those with late-onset bipolar disorder, generally defined as those who developed the disease after 50 years of age.

3.1 In general, age-related changes in the brain and major organ systems affect the pharmacokinetics and pharmacodynamics of psychotropic agents. Elderly patients also tend to have a decreased ability to metabolize medications and an increased sensitivity to adverse medication-related side effects. In addition, the risk for drug-drug interactions is high in an elderly BPD population. This is because most geriatric patients are taking medications in addition to psychopharmacologic agents. There is a need for well-controlled studies in elderly bipolar patients to understand the pathophysiology of the disorder late in the life cycle. Such studies will help us to understand the proper psychopharmacologic agents and unique treatment needs of this population.

4. I have talked with my psychiatrist about BPD and the elderly since I am at the age of 67 now in the elderly category. His view is that we need to tailor my medications to my bipolar I disorder and go from there. We are, at present, working out a meds package for me to run with in the years immediately head, as I go through the last years of late adulthood(68-879) and old age, 80+, if I last that long.

5. Before offering some concluding words I'd like to quote from a recent article entitled: "Mitochondrial Dysfunction in the Pathophysiology and Treatment of Bipolar Disorder." The language is complex, but it is worth including especially for readers with the interest. "The depressive phase of BPD contributes to the majority of morbidity and mortality in this illness," so begins the article. Impairments in physical and social functioning resulting from depression are often as severe as other chronic medical illnesses. Few of the treatments in use have resulted from an understanding of the pathophysiology of bipolar disorder. Undoubtedly, a greater understanding of the pathophysiology of bipolar disorder will lead to improved treatments.

Current theories of depression suggest that mood disorders are associated with impairments of cellular resilience and structural plasticity possibly a result of abnormal cellular energy metabolism. Studies with Magnetic Resonance Spectroscopy (MRS) in bipolar subjects show reduced brain intracellular pH and reduced ATP. Cellular energy generated by mitochondrial oxidative phosphorylation from glucose via the electron transport chain is stored as ATP, which provide neurons and glia with energy required to maintain their function. Mitochondrial dysfunction and its inability to compensate for increase in ATP demand might lead to impaired cellular resilience believed to be involved in the pathophysiology of bipolar disorder. Abnormal regulation of nuclear genes coding for mitochondrial proteins in the hippocampus of bipolar subjects provides further evidence of mitochondrial dysfunction in bipolar disorder.

Coenzyme Q10 (CoQ10) is an essential cofactor in the mitochondrial electron transport chain necessary for cellular energy generation. Exogenous administration of CoQ10 attenuates ATP depletion and has anti-oxidant properties. In light of the above evidence, it is hypothesized that bipolar disorder is associated with mitochondrial dysfunction as evidenced by impaired brain energy metabolism and that administration of CoQ10, a mitochondrial enhancer, will restore mitochondrial function. To accomplish these objectives, we will compare mitochondrial functions in bipolar depressed subjects to 26 healthy controls matched for age, gender and BMI. Measures of mitochondrial function will include brain lactate levels (a product of anaerobic glycolysis) with H+ MRS, 2) assays of mitochondrial function in cultured fibroblasts and platelets, and 3) gene expression of mitochondrial and nuclear genes using a cDNA Microarray. I leave it to readers with the persistence to follow-up on this information.

CONCLUDING WORDS

With the most recent visits to my current psychiatrist in 2012, I bring to an end my account of the last 50 years of the major manifestations of this BPD in my life: 19 to 71. As I say above in this lengthy clinical story, the years from conception to 18 which I have commented on briefly had their problems but, in retrospect, the main part of my story did not begin until the last week of September 1963 and October when that Black Dog came into my life and I had no idea what it was.

end of document

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