1.11 Data from the United States on the lifetime prevalence of this disorder--and mine has been a lifetime of BPD--indicate a rate of 1 percent for Bipolar I, 0.5 to 1 percent for Bipolar II or cyclothymia and between 2 and 5 percent for sub-threshold cases meeting some but not all criteria


1.12 I would like to close this introductory section with a general comment about the increasingly close relationship between the pharmaceutical industry and the American Psychiatric Association (APA) and about a sub-field of philosophy and sociology known as hermeneutic phenomenology.

1.12.1 Since at least 1980 when by illness was given the label BPD, there has been a growing tendency in the mental health professions to interpret everyday emotional suffering and behaviour as a medical condition that can be treated with a particular drug. Hermeneutic phenomenology, a field within both philosophy and sociology, is uniquely suited to challenge the core assumptions of this particular form of the medicalization of BPD, among other psychiatric disorders. Hermeneutical phenomenology can function within psychiatry: (a) to expand psychiatry's narrow conception of the self as an enclosed, biological individual and (b) to assist psychiatry to recognize the ways in which our experience of things--including mental illness--is shaped by the socio-historical situation in which we grow. Informed by hermeneutic phenomenology psychiatry's first priority, so it could be argued, is to suspend the prejudices that come with being a medical doctor in order to hear what the patient is saying. To this end, psychiatry can begin to understand the patient not as a static, material body with a clearly defined brain dysfunction but as an unfolding, situated existence already involved in an irreducibly complex social world, an involvement that allows the patient to experience, feel, and make sense of their emotional suffering.

1.12.2 This increasingly close relationship between the pharmaceutical industry and the American Psychiatric Association (APA) and this sub-field of philosophy and sociology known as hermeneutic phenomenology offers the sufferers of BPD a potentially useful line of inquiry in the future, but it is not a line of inquiry that I investigate in this statement. For my story, my account and my analysis, I see these two directions of inquiry as tangential to the central thrust of both my story and its treatment both in the last and the future.

2. My Experience of Manic-Depression:
Phase One--The First 37 Years 1943 To 1980

2.1 In the first 37 years of my life I had many episodes of various kinds of emotional imbalance or disorientation, themselves of varying lengths and intensities, ranging from a euphoric, impetuous, expansive or high mood to a depressed, grey, low energy or despondent mood. Indeed the range of mood in these 37 years was much more extreme, but the complete/extreme range was rarely experienced. In these years I learned various self-monitoring skills as well as some self-reinforcing tactics. Sometimes these symptoms affected my day-to-day life severely and negatively, sometimes positively and sometimes the affect was non-existent, insignificant and hardly noticeable.

2.2 After many experiences on the fringe of a normality that was my usual modus operandi or modus vivendi, as it is said in Latin , on the fringe of what I saw as my general everyday experience of life, an experience that is sometimes called the quotidian by writers, poets and novelists, I was diagnosed as a MD in May 1980. I was treated by a psychiatrist in Launceston Tasmania while in hospital. I had often been on the fringe of this disorder, as I say above, a borderline zone, a limen as some historians call it, a border territory, a zone between normality and various behavioural extremes and eccentricities from my birth in 1944 to 1980. But in 1980 the symptoms were extreme and required hospitalization. The treatment regime in 1980 was lithium carbonate, an antimanic medication for the treatment and prophylaxis of BPD. Lithium was the first really successful mood stabilizer used by doctors to treat MD, an illness that in the 1990s began to be called BPD. This medication cushioned the effects of extreme depression and hypomania and prevented their effects from striking at my life. The perils of BPD lie in what I did in the midst of hypomanic episodes to deal with: decreased need for sleep, decreased self-control, increased sexual desires, irritability, rage, risk-taking behaviours and, in my 1968 and 1979-80 episodes, schizo-affective or psychotic states; and in the midst of depression periods with moroseness, extreme melancholia and suicidal wishes.

2.3 My history to that point, to 1980, had been far from smooth and linear as my remarks above indicate. Those thirty-six years had often been bisected, polarised and traumatised. As I indicated above I have written a more detailed account of these years elsewhere but this outline, this brief sketch here, of particular episodes and the periods between episodes will suffice. My experience of these highly diverse emotional and psychological swings of mood in everyday experience away form the norm, from my norm, is only part of my story. But it is a crucial part. Everyone has their story for everyone experiences all sorts of abnormal eccentricities and health problems in life, some people of course more than others and some more traumatic and intense than others.

2.4 My account of the years from 1943 to 1980 follows. I try, in writing about and in summarizing these first 37 years of my life, not to overstate my case, nor to understate it, but give an account of those first 37 years which I refer to here in this general statement as phase one of my bi-polar life. In some ways the inclusion of the names of those doctors who treated me over the years in this first phase and in later phases would personalise this account, but names are not that important and to include them here in this narrative causes confidentiality problems and raises privacy issues for some readers and for people in my own past who might not want to be mentioned. This question of confidentiality and privacy is especially true at some internet sites where posts are rejected if names are included in any posting at the site concerned---and so I leave names out. Those whose names I could mention would not be troubled by their inclusion here, not now, not in 2008 after an extensive destigmatization of the disorder in recent years and after so much of my experience and so many of the people concerned are now, what you might call, ancient history.

2.5 1 I certainly appreciate the medical and clinical work of: (a) several of the doctors I went to in my childhood, adolescence and adulthood, (b) the psychiatrists who have treated me since June of 1968, nearly four decades ago and (c) many family members, friends, colleagues and associations, some known well and others hardly at all, who have helped me ride the waves when the disorder raised its head yet again along the way, the road of life.

2.6 Comments on My Ante-Natal, Neo-Natal,
Childhood and Adolescence Life: 1943-1963

2.6.1 As I refer to above, I had some experience of what may well have been BPD in childhood as far back as infancy and at the toddler stage, all of the pre-school years, 0-5, of early childhood development. My mother nearly died in the first month after my birth, the implications of which it is not my intention to go into here. If there are any significant implications of this birth process and/or events in my ante-natal and neo- natal phases of my life, I do not examine here, however important they may be in the aetiology of this illness. Before the age of five there is evidence that my behaviour had some of the features of what is now called Attention-Deficit/Hyperactivity Disorder (ADHD), but it is difficult to disentangle those features from those of BPD. For the most part, though, I did not manifest BPD symptoms like: elated mood, grandiose behaviours, decreased need for sleep, racing thoughts or hyper-sexuality. Children are developmentally incapable of many manifestations of BPD described in adults; for example, children do not "max" out credit cards or have four marriages, pre-puberal and early adolescent age equivalents of adult mania behaviours. Still, as David Healy emphasizes in his book Mania: A Short History of BPD, some doctors are now associating BPD as beginning in utero.

Perhaps in a later edition of this essay I will attempt a more detailed outline of what I recall from these years of early childhood, but my recollections are minimal and it is difficult, if not impossible, to excavate my memories from those years at this late stage of my life. It is not my intention to comment further on these early years except for the occasional passing reference when it seems appropriate.
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2.6.2 Through middle and late childhood, say, the age of 6 to 12(1950-1956) into the puberty cusp of 12/13 in 1956/7, I did exhibit personality features, behaviours or symptoms that had features of BPD, at least to a limited degree, or so it could be argued if not proved: (a) a lack of control of my emotions, impetuosity, lack of emotional restraint, hyper-sexuality and (b) a far too intense activity threshold what is now called hyperactivity, mild mania or hypomania. It should be emphasized in this context, though, that mania is now considered by many in popular culture as a pleasantly grandiose, somewhat overactive feeling and behaviour orientation, but is not considered as evidence of a disorder or of a maniacal posture. I recall at the age of 12/13, at the onset of puberty, exhibiting inappropriate or precocious sexual behaviour, although the particular manifestations only involved one episode which constituted groping and an attempt to kiss a girl who did not want to be kissed. In addition, in my years of late childhood(8 to 12) I was involved in: (a) stealing items from shops and selling them; (b) one breaking and entering experience in which the charge was dropped and (c) excessive intensity expressed in sport and other activities.

Adolescent BPD or adolescence presented me with an accentuation of puberty and teen-turbulence caused by hormonal shifts. Society value shifts in the 1960s accentuated my tensions and behavioural problems even more, or so it seems to me, as I look back from the perspective of half a century. My mother’s understanding, commitment, perseverance and patience, even though she did not know that I even had BPD, is now in my memory bank and in my greater appreciation for my mother than ever before.

2.6.3 Although symptoms of BPD that I exhibited in childhood and adolescence are largely not described here, I could go back to my birth and, indeed, to conception itself and my in utero life as I intimated above, for possible origins and manifestations of BPD. The relationship with my mother, my sexual proclivities, my OCD tendencies could all be described, could be gone into, in more detail. I have also written about this subject briefly in my memoirs. I do not attempt in this now quite lengthy account to describe this period of my life in more detail, nor do I discuss my death wish or my suicidal tendencies during the many years of BPD beginning in the last months of my adolescent years, in October of 1963, during which I experienced the death wish for the first time due to the intensity of my first depression. Before the official diagnosis of manic-depression in 1980 my death wish was only associated with a few periods of intense D. I do not allude to this death wish except en passant and, then, only in the most cursory fashion.

2.6.4 I don’t think I will ever know enough about the early years in my life before the age of 18 anyway, to assess whether my short periods of behavioural disorientation were examples of: (a) a mild-mania, hypomania, (b) BPD, (c) an affective disorder of some kind like schizo-affective disorder or (d) just a mild form of OCD. The very validity of the diagnosis of BPD in paediatrics and in adolescent studies is now in question becoming, some say, a simple catchall applied to explosive and aggressive children and other kinds of idiosyncratic behaviour. Others say that many behavioural abnormalities are finally being recognized as part of a single disorder or existing on a single continuum.

2.6.5 Keeping sexual stimuli under control has always been a struggle for me to regulate so that thoughts of a sexual nature did not claim too great a share of my attention. With the years, the more than half a century since 1956/7, the opportunities to go over the top and to let physical/sexual temptations assume too great an importance have increased. My mother took a liberal attitude to my sexual frustrations and this liberal attitude became part of my own attitude to the battles I had to face in this domain of life’s tests.

2.6.6 It was not until much later in life, though, that I began to see my aberrant childhood behaviours and my sexual and other aberrations(stealing, breaking and entering, excessive intensities) at puberty and then in adolescence as possibly having a link with my future mental illness. It was not until I was 19 in 1963 that any characteristics of BPD became quite clearly apparent, pathological and, in retrospect, could be called part of BPD and given that medical diagnosis. At the time, though, in 1963 no doctor would have given, or at least gave me, that diagnosis. Looking back to the age of 19 in October of 1963, I recall feeling a depression so deep it was like ‘a sickness unto death’ that I had never experienced. It was a sadness so pathological that it made me feel suicidal, like death not warmed over, as one could say colloquially. It does not surprise me that the third leading cause of death among people aged 15-24 is, in fact, BPD. I could very easily have been one of those dead souls especially back in the early 1960s when there was such little understanding of this illness.

2.6.7 One can read about this intensity of depression in many fields of literature and of mental health, although the word ‘depression’ does not seem to have entered the lexicon until about 1900. The desire to die at that time was overwhelming. But I did not talk about it to anyone except perhaps my mother, although I honestly can not now recall the extent of my openness with her. She knew I was depressed but neither she nor I really understood the dynamics or the intensity of the depression. I think it was assumed that I would grow out of it. And I did. By December 1963 the depression began to lift. I wrote my December exams at university and I continued with my first year studies in liberal arts.

2.6.8 These behaviours, this depression, at the age of 19 or any of my behaviour before that last year of my teenage life(1963-1964), did not result in my receiving any medical attention. The first formal diagnosis of my illness was labelled a schizo-affective disorder(SAD) in 1968. SAD is a sort of hybrid condition between bipolar disorder and schizophrenia, although this distinction may be somewhat artificial. It may be inappropriate to have a discrete cut between the two disorders when both may represent part of a spectrum and symptoms of both disorders were part of my experience during the last half of 1968. This situation involved the possibility of a serious risk of harm to myself or others and required in July 1968 what is termed involuntary commitment to hospital. This case involved a severe manic episode with dangerous behaviour and depressive episodes in August with suicidal ideation.

In retrospect, I now see the autumn of 1968 as the first formal diagnosis of my BPD, although I was not to receive that diagnosis until 1970 when I visited a psychiatrist in Kingston Ontario. At the age of 19, though, I was given lots of advice from religious to common-sensical: diet, exercise, prayer, vitamins, interesting leisure distractions/interests like horse-riding, watching TV, music, et cetera. After several months to several years, 1963 to 1968, the emotional aberrations disappeared or could be said to be sub-threshold at least for a time. My episodes over those years and in the years December 1977 to June 1980 seemed to exhibit quite separate and distinct tendencies and patterns.

2.6.9 Hypomania(H) was always characterized by elation and D was always characterized by varying degrees of very low moods. Such an observation seems now to be so obvious as hardly to require a mention, but at the core of my experience of this problem was either D or H and the impact of their various symptoms. The boundaries between normality and abnormality, health and pathology are also blurred and indistinct. In addition they shift from person to person, doctor to doctor and decade to decade making one’s understanding of the problem more complex, more difficult. Within those five years, 1963 to 1968 though, the permutations and combinations of emotional variation were enough to being tears to the eyes of a brass monkey, as my mother used to say. Looking back in retrospect at those last years of my formal education, I see it as a miracle that I ever got my degree and my teaching qualifications labouring under such emotional chaos from time to time and often, week after continuous week in a variegated pattern. Although the pharmaceuticalization of the post WW2 modern world had began in earnest by the 1960s, it had not taken off that earnestly for the behaviours and symptoms I exhibited back then to be treated by pharmaco-therapy.

2.6.10 Sometimes there was a return of incapacitating symptoms; sometimes I simply exhibited impetuosity or lack of emotional restraint; at other times my moods were expansive, quasi-manic. Perhaps, as some of the BPD literature suggests, I was affected sporadically by the extremes of a psychomotor retardation and agitation which is characteristic of this illness. Combinatory, lateral, uneven, unusually sensitized thinking, particular sensitivity to energy levels and a state of increased awareness were all part of my experience in these five years. It is difficult to describe these five years in retrospect given the bizarre and chaotic nature of the experience. Given, too, a general context of a degree of normality and the inevitable routine and quotidian nature of life that went on inspite of everything, inspite of the emotional problems makes the description, after forty years, difficult.
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part 6 to come if desired by readers at this site.-Ron in Tasmania