Samuel M. Seltzer, Clinical Psychologist, Retired
I’m a professional psychologist and one who has been diagnosed with bipolar disorder (aka, manic-depressive illness [alternation of periods of depression and mania]).
My first recognizable depression occurred in while I was a part time graduate student, working full time in a state hospital, married and sharing the responsibilities of raising our three small children. Fortunately, I had sufficient insight to be aware of my need for immediate treatment. I consulted a psychologist/psychiatrist who, upon listening intently to my brief autobiographical sketch, immediately came to the conclusion that I had manifested symptoms of bipolar disorder earlier in my life, which had remained undetected until the current episode.
Suffice it to say, with appropriate medication and psychotherapy, I entered remission after a relatively short period of time. The illness had not been so debilitating that I couldn’t continue to work, but I did resign from my graduate courses. (The severe anxiety or panic state accompanying the depression made that mandatory.)
After a year or so, I found myself engaged in a great deal of hyperactivity and entertaining some unrealistic thoughts (delusions of grandeur). I woke up one morning to find myself in a camisole (restraint sheet) in a bed in a psychiatric hospital. Obviously I had entered the manic (extreme hyperactivity and heightened feelings of elation inappropriate to environmental demands) phase of my illness. I remained hospitalized for about six months. Fortunately, I had garnered sufficient “sick time” so that my job was never in jeopardy. Upon my release, I returned to work, but shortly thereafter, I once again developed symptoms of depression and resumed medication and psychotherapy, which enabled me to continue working and supporting my devoted, understanding and caring family.
I then progressed to several positions of higher responsibility over the next few years and became heavily involved in community affairs. At one time, I held the positions of Masonic Lodge Master, Boy Scout District Chairman, Rotary President and Civil Service Union President. I became instrumental in the organizing and founding of a Rotary-sponsored camp for severely handicapped children, serving as president and chairman of its board of directors for three years. I also taught some undergraduate and graduate courses at nearby universities during that period.
A few years later, I seized an opportunity to accept the position of director of a newly created narcotic rehabilitation center in the City of Buffalo, New York. Within a period of a few months, I recruited, hired and trained the 114 staff members who were required to open and operate the facility.
Predictably, one and one half years after embarking upon this highly successful venture, I again fell victim to depression and felt compelled to resign that position.Once again, medication and psychotherapy helped me level off.
Shortly thereafter, a new position was created at that facility called “Chief of Adult Habilitation Service.” I received that appointment, which involved a massive reorganization of the structure of a group serving 308 mentally retarded and developmentally disabled adults. This position called for the planning, coordination, retraining and direction of an interdisciplinary staff of 210 clinical and support personnel. I enthusiastically and energetically set about accomplishing this task and, after succeeding, discovered I became unable to curb my hypomania (hyperactive behavior coupled with feelings of ebullience, not approaching unrealistic proportions). I rapidly progressed into another manic state which required voluntary hospitalization for about a week. By 1970, the United States Food and Drug Administration (USFDA) had sanctioned the use of a drug called lithium carbonate, which became the medication of choice for bipolar illness. My psychiatrist wisely prescribed it for me. Within weeks, along with psychotherapy, I was once again restored to a more normal functioning level. And so, for 23 years, faithfully taking lithium as prescribed, I remained symptom free from both depression as well as mania.
By 1981, all three of my children had graduated college and gone on to further graduate study. My wife, Evelyn, and I, after 31 years of marriage, came to a parting of the ways shortly before my retirement from the New York State Civil Service in 1982. But after only eight days of retirement, I answered an ad for a position as a school psychologist in a district located about 80 miles away from where I was living. Immediately after the interview, I was hired, and actually went to work two hours after I first set foot in that community.
By 1990, after I had successfully served a total of four additional school districts, I was approached with an opportunity to serve as a psychological/psychiatric consultant to one of the state agencies. This turned out to be the most lucrative position I was fortunate to have held. I began to notice that I was working longer hours than I ever had before. Also, I felt so self-confident that I progressively reduced my dosage of lithium to the point where I wasn’t taking any at all. The volume of referrals began to increase, and before long, I was rendering service in Buffalo, Jamestown, Olean and Rochester, setting up private offices in some of these communities.
However, I failed to recognize that I was slipping back into an extremely hyperactive lifestyle and began to make a series of very poor judgment calls, ultimately resulting in my termination.
By this time, I had already moved into a new home in which I had included an office, attempting to establish a private practice, and was employing the services of two full-time secretaries. Soon thereafter I also met a remarkable woman named Donna and married her, after a very brief courtship, on my 67th birthday.
Not unexpectedly, I found myself in the depths of a fairly profound depression once again, and resumed taking lithium upon prescription from my family physician. But it did not seem to be helping. I therefore consulted a non-medical psychotherapist who advised me to consult a psychiatrist, who could review my medical requirements. The psychiatrist prescribed Prozac, an antidepressant, but I continued to be lethargic, sleeping almost 16 hours a day, and feeling most useless. To further complicate matters, I noticed that I had developed a partial amnesia (loss of memory), aphasia (loss of the ability to find correct words to express ideas), and an inability to navigate without difficulty. I couldn’t even perform routine computer functions because I no longer remembered the appropriate commands. Donna drove me to the emergency room of a local hospital, and I was diagnosed as possibly having had a lithium toxicity reaction. The next day, I consulted with the psychiatrist, who thought I had a transient ischemic attack (mild stroke) and had me discontinue all psychotropic medications.
A month later, almost to the day, I was hospitalized for what very well may have been a heart attack, although the final diagnosis was never clear-cut. After a six day stay, I was discharged. Oddly enough, I discovered that I no longer experienced the symptoms of depression.
However, we realized that I had amassed what seemed to be a mountain of debts, so, reluctantly, we sold all the office equipment, voluntarily arranged to have the leased car repossessed, moved to more humble quarters in a two bedroom apartment and filed bankruptcy proceedings, which were recently finalized.
During this time, I again became aware of depressive symptoms coupled with extreme anxiety. With Donna’s support, we convinced the psychiatrist to prescribe appropriate medications. As the months went by, I began to feel better. I affiliated once more with Rotary, resumed playing duplicate bridge twice a week and began to “surf the Internet” frequently. In contrast to previous behavior, I became determined to continue the medication, despite the onset of remission.
Today, as I write this article, I am still engaged in these activities and have created several pages on the World Wide Web (WWW) for myself and the local Rotary Club of which I am now Secretary. I feel pleased with myself and productive, and no longer harbor negative feelings about my self-worth, as I did during those periods of depression, nor am I excessively preoccupied with flights of fancy and grandiose achievement.
If there is anything of value to be gained by reading this account of my experiences with depression and mania, it is this:
1. Mental illnesses are very painful and, at times, crippling, but there is ‘always’ a light at the end of the tunnel.
2. That illumination comes from the knowledge that there exist many medications to treat these problems. Certainly, there is no one single formula which will relieve each of us, but with competent professional supervision and periodic medical review and adjustment, a very satisfactory remission is possible within a relatively short period of time for most of us. Prescription of any psychotropic medication should, of necessity, be highly individualized and tailored to fit each patient’s specific brain chemistry.
3. Relapses may occur from time to time, but generally they are due more to attempts to change or stop medication which, too often, results in a shift of the chemical balance in the brain, thereby causing symptoms to reappear. In my case, as I mentioned previously, I enjoyed a remission of some 23 years duration. Had I not attempted to self-medicate, I am reasonably confident that I should have remained symptom-free to the present day.
4. Finally, the concept that only medication is necessary to achieve remission needs definite qualification. Properly prescribed pills or capsules generally prepare a person to be much more amenable to psychotherapy. It is the combination of the two which does the job. However, periodic monitoring of ones’s emotional state is essential to discover if the effects of variations in environmental conditions might warrant an adjustment of dosage. It is no sin to continue to take psychotropic medication in order to be stabilized. Need I say more than simply mention diabetes, hypertension, arthritis, just to name a few otherwise debilitating conditions?
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