Sunday, August 08, 2010

Rage Reaction Part III

Every time I’ve come close in therapy to getting to the bottom of my problems, I’ve sabotaged it somehow. I’m not sure what’s down there, but I know I’m afraid to face it. A big part of me hopes that it’s from another lifetime because if it’s what the docs all think it is, I don’t want to think of anyone in my family doing it. They think that I was severely physically or sexually abused when I was a child. I admit I’ve always been afraid of pain—of hurting myself or getting hurt. I was a very cautious child. But then, I also fell down a flight of stairs in my walker a week before my first birthday and they asked if I’d ever lost consciousness for any length of time. I don’t know if I did that day.

I remember being two or three watching my mother take down the laundry in the back yard and being scared because I had wet my pants and I knew she was going to spank me. I remember crying when she spanked me and her saying, “I’ll give you something to cry about,” and spanking me longer and harder. I don’t recall if she ever spanked me anywhere besides my butt or if she used anything other than her hand. I seem to recall her letting me touch the iron to see how hot it was, and burning my finger. I also remember watching my sister hit my nephews with various implements from leather belts to wooden spoons and since she has told me that she was angry that my parents adopted me when she was fifteen and left her to babysit me, I can’t help but wonder if I haven’t been looking in the wrong direction all this time and leaving out a major suspect. I see her as a parent figure, but I’ve never seen her as a disciplinary figure. Yet she must have been when she babysat in those early years before she graduated from high school, got a job and got her own apartment. Food for thought…

As I said, the docs here at the North Chicago VA (which is in the process of merging with the Great Lakes Naval Hospital and becoming the James Lovell Federal Health Care Center) all wondered why I was on so many meds for bi-polar disorder and all asked what my rage reactions had to do with it. One of my doctors thought it might be a seizure disorder, so she arranged an appointment for me with a neurologist. I met this doctor on Wednesday, August 4, 2010. She questioned me about my rage reactions and then explained what is happening.

Apparently, I react to some trivial threats as though I was in a life and death situation. The emotional part of my brain goes into full panic mode. And once it’s there, the intellectual part of my brain cannot stop it. She said that it’s like getting on a rollercoaster. You go up that first hill and once you reach the top you have to scream your way through the whole ride. And that’s exactly what I do. She said that the voice I hear is the rational, intellectual part of my brain trying to control the emotional part of my brain which, of course, is on the roller coaster screaming for my life.

Celexa, the medication that I’m on for the depressive part of my bi-polar disorder, is good for controlling the emotional part of my brain. Gabapentin or Neurontin, the med I’ve been begging the docs to take me off of slows the intellectual part of my brain making it ineffectual against the emotional whirlwind and suppressing my higher functions to the extent of causing dementia. I’m weaning off of that. Buproprion or Wellbutrin, the last med my Danville docs added, actually makes the emotional part of my brain more sensitive to fight-or-flight stimulation (so we’re weaning off of that next), and topiramate or Topramaz [sp?] suppresses the irritability of the emotional brain, and we’re increasing that. The latter med is what my new shrink here chose to replace my gabapentin and she was slowly increasing the dosage of one as she weaned me off the other.

Well, that’s the scoop. At least now I know what's happening and why I can't stop it. I guess now the real work starts again. We have to get down to the bottom of what makes me perceive trivial threats as life-or-death and react to them accordingly. I really, truly hope it comes from a past life, although I believe my mother was beaten and sexually abused. Her father sexually abused my sister when she was young and he babysat her. I don't know if he was ever alone with me since he died when I was two.

At any rate, how can anger management, the Twelve Steps, Rational Emotive Therapy or any other form of Behavioral therapy work when I'm fighting for my life and the rational part of my brain is right there trying to stop it but is unable to do so? I guess we need to uncover and face whatever causes these extreme panic attacks.

Rage Reaction, Part II

Yesterday, I described the three parts of my rage reactions and suggested three causes. In the late 80s I was diagnosed as being clinically depressed at the Lakeside VA Medical Center in Chicago. They put me on Prozac (with the rest of the Western World), and I was somewhat okay for about a decade. I still seemed to have pretty severe pre-menstrual mood problems. I realize now that I am bi-polar and that I also suffered from pre-menstrual dysphoric disorder. Most of my episodes took place close to or the day before onset when I was younger. In my mid-forties, I moved to Washington, DC, and was unable to keep up with my psychiatric appointments. The result was that I stopped taking my Prozac and started bouncing off the walls. I was having racing thoughts accompanied by racing speech. I misunderstood what people said and answered what I thought they said (which made for some bizarre conversations). I fixated romantically on a man who was not interested in me and I became increasingly irritable, or I slept. My housemate recognized the signs of bi-polar disorder and got me admitted to the VA. They kept me for two weeks—one to observe my behavior and confirm the diagnosis, and one to start me on medication and be sure it was working before they turned me loose.

That worked until menopause when the hormonal changes overcame my meds. I started going off on people more often and more severely. I had moved back to Chicago and had a different doctor who changed my meds when I realized I was gaining weight on the Prozac. I’d gone from 200 to 266 pounds in less than a year. One of the meds she put me on took me up to 296 before we found a combination that stopped the weight gain. Meanwhile, no combination of psychotropic meds seemed to help. I suppose hormone therapy would have helped, but I threw a pulmonary embolism (blood clot in my lung) and almost died from taking The Pill, so I did not want to go near estrogen again. I was afraid to even take any over-the-counter remedies for menopause. So, I was like Oklahoma and Kansas during a hot summer. You never knew when or where the next storm would strike. Even I was afraid to take me out.

Before I got through menopause I moved yet again downstate to Rantoul, Illinois, but I had a car and was able to drive to the Danville VA for treatment. I have always been grateful for the care I have received from the VA, but I was frustrated with my psychiatrist in Danville. As my episodes became more frequent and more severe and I begged him to change my medications, he simply added meds to the ones I was already taking, because one of the meds I was on helps relieve the pain of periferal neuropathy for diabetics. I kept telling him that I'd been controlling my diabetes and that I did not have periferal neuropathy, but he wouldn't listen to me, so he just kept adding more meds. And I was sure that particular medication was also responsible for causing dementia. By the time I moved up here I was becoming so forgetful that I asked to be tested for Alzheimer’s. I am so grateful that I don’t have that. But all of my doctors up here have expressed shock at the number of medications I’m on for my bi-polar disorder and as they’ve listened to my descriptions of my rage disorder, they’ve all asked what that has to do with being bi-polar. I always thought that was the main component of the manic side of the disease for me.

I still haven’t answered the original question, have I? Well, I’m almost sixty and it started when I was thirty so it’s a long story. Geez—did I just admit my real age?

Rage Reaction, Part I

One Woman’s Journey

As many of my friends know, I am bi-polar and I fly into rages with very little provocation. I have injured myself on occasion, but fortunately have never injured anyone else. I’ve had the police and even the fire department called on me and I’ve called the police on myself. Most of the time, I’m a rational person and people usually describe me as “sweet.” So how does a “sweet” person find herself in front of a karaoke bar being restrained by two of her best friends while she tries to pummel first a very imposing, muscular doorman, and second a (fortunately) thick window? I’ve been wondering that most of my adult life.

I rate these episodes on the Fugita scale because they resemble tornados. They seem to come out of nowhere, do a lot of damage and leave a wake of debris that needs to be cleaned up once the shock wears off.

Usually something triggers it—some person or issue. It starts with a temper tantrum in which I yell obscenities, throw things, break things, and rage around. That gives way to what I call “the screaming heebie-geebies”—primal screaming until I lose my voice. During this phase it’s as though my brain splits in two. Doctors always ask if I “hear voices” and I always say no, but the truth is that I know what the phrase “she was beside herself” means, as there is a voice that sounds as though it’s on my left side telling me things like, “this is inappropriate behavior,” “ladies don’t use that kind of language,” “you’ll lose your voice,” and “you’ll never be able to sing again.” I count this noisy out-of-control/split personality thing as one phase even though it seems to have two parts: verbal and non-verbal. The Voice is there throughout.
The second phase is crying and apologizing. The first time I recall this happening, my husband kicked me out of the house and I paced up and down the sidewalk mumbling, “This shouldn’t be happening to me. I have a Program.” At the time I was active in Overeater’s Anonymous, working the Twelve Steps with a sponsor and I couldn’t understand why I was going off. No one in those days mentioned dual diagnoses or medications or anything. The crying and apologizing usually lasts until I become dehydrated and have no tears, or exhausted and can barely keep my eyes open.

The final phase is, of course, sleeping it off—unless you count all of the amends I have to make later, or how long I had to keep the cast on when I broke my wrist during an F-Four. The karaoke one was an F-Five, and I’ve been barred from that establishment (not that I blame them).

So, what the heck is going on with me? Am I an overgrown, over-aged spoiled brat? Am I crazy? Or is this some sort of strange seizure disorder? Well, we haven’t ruled out the first. I carry a card that says I’m the second. (No, I’m not certifiable; I’m certified.) And we’ve ruled out the third. But, there is a fourth explanation and I find it fascinating. “Stay tuned for Part II.”