PMS or Bipolar II – You Choose

There is evidence in America that we are shifting our identity and not in a good direction. As we learned in the previous essay  Age of Anxiety  a nation can move its identity toward or away from fear by altering the content of its narrative. Whether neurotic behaviors or drug use are waxing or waning, would indicate which direction we are going. The story of one person does not a trend make but as Ayelet Waldman’s story unfolds we get the feeling that she is far from alone in the challenges she is facing.

It took courage for Ms. Waldman to share her experience and her suffering. The least we can do is honor her cautionary tale by taking a fearless look at our own identity. She had some difficult decisions to make, we all do. Walk in her shoes for a while and imagine having to make choices similar to hers. Does she have Bipolar II or PMS?

Her syndrome, the complex of symptoms, was complicated and devastating, so much so that she contemplated suicide. Mood swings and temper tantrums, overspending, exhilarating and fruitful periods of creativity (writing three novels in 6 months) describe some of the behaviors that led her to seek professional help.

Enter the first of two psychiatrists. Probably influenced by the DSM-IV (Diagnostic and Statistical Manuel of Mental Disorders), he pronounced that Waldman suffered from Bipolar II disorder, a variant of Bipolar I formerly known as manic depression. She was frightened by this diagnosis because “1 in 5 people with bipolar disorder will commit suicide.” 

How is this condition treated? For seven years Waldman took a dizzying array of psychotropic drugs. “I have taken mood stabilizers, anticonvulsants, antipsychotics, selective serotonin reuptake inhibitors, norepinephrine-dopamine reuptake inhibitors, sedatives, hypnotics, anti-anxiety medications and more. Each drug worked for a while, sometimes a few days, sometimes a few months.”   

Before we continue Waldman’s story let’s bring in the Simple Reality concept of the continuum from fear to compassion, from clueless sleepwalker to awakened Buddha.  It is easy to see that Americans derive their identity from the fear end, the unconscious end of that continuum.

In addition to fear on the dark end of the continuum we also have the intellect, reaction and emotion.  We would do well to move these behaviors toward the related pairs of intuition, response and feeling (what Jung called the “feeling function”). Both Waldman and her first psychiatrist and maybe other care-givers involved in her diagnosis relied heavily on their intellects and the DSM-IV. There were no “intuitives” in the room or if there were, they held their tongues—for seven count ‘em—seven years!

Seven years of: “With every new pill there were new side effects. Since S.S.R.I.’s made me gain weight and lose my libido, standard practice dictated that we add new meds to combat the weight gain and to pump up my sex drive to something approaching existent.”   Entering the often increasingly slippery slope of a drug regimen finds inner wisdom, self-reliance and the authentic power of the true self drowned out in a cacophony of fear.

The intellect isn’t patient, it doesn’t count to ten, breathe and “go inside.” It wants to diagnose, prescribe, dispatch the anxiety of uncertainty and move on. Eventually Waldman’s still small voice, whispering misgivings, allied itself with her intellect (they make a good team) and began to question the original diagnosis. Her research revealed that her physical symptoms and mood fluctuations matched and were synchronous with her menstrual cycle.

The female psychiatrist at the Women’s Mood and Hormone Clinic at the medical center of the University of California determined that Waldman was not suffering from Bipolar II but from premenstrual dysphoric disorder. Prescribing the specific S.S.R.I. which inhibits the enzyme 3-HSD from metabolizing progesterone, Waldman found that within 20 minutes of taking the pill her mood lifts. She also took an anxiety pill for the worst of the hormonal effects and supplemented those with cognitive behavioral therapy—a big improvement from her “pills galore” years.

Health care professionals in paradigm B are doing the best they can, considering that they are immersed in a dysfunctional institution, a toxic context.  As a consequence, the narrow focus of the practitioner leads to an over-reliance on the DSM-IV and psychopharmacology; a significant handicap, often discounting the patient’s broader experience.  

In the healing process a healthy identity is needed, one that is self-reliant and advocates for itself, one that relies more on intuition than the intellect, one that values response over reaction, and one that lives in the present moment beyond the disabling and toxic influence of fear.

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References and notes are available for this essay.
For a much more in-depth discussion on Simple Reality, read  Simple Reality: The Key to Serenity and Survival,  by Roy Charles Henry, published in 2011.