Now 14, Kate has struggled to maintain any emotional equilibrium since the start of her eighth-grade year. Middle school is hard enough as is, but especially for girls riding the hormonal rollercoaster, and things have been steadily on a downward spiral since November.
The level of pharmacopeia — multiple medications addressing multiple issues — was not touching the problem. Adding lithium — aka the “gold standard” drug for treating bipolar — didn’t help. Kate’s generally upbeat nature was being overwhelmed by pressured speech, tears, anger, sadness, and rage.
When she could not stop twitching a few nights ago, we had to take her to the emergency room. After consulting with doctors the next morning, we knew that something more had to be done, both with her meds and to help guide her out of an increasingly dense wilderness.
We had entered our own personal adjustment bureau.
••••••
According to the Child and Adolescent Bipolar Foundation (CABF), the past decade has seen a 40-fold increase in the diagnosis of children with bipolar, even though it remains far below the rate for adults. A National Institute of Mental Health study notes that at least 65 percent of adults with bipolar felt that it started in childhood or adolescence.
For as long as I can remember, Kate has confronted the various — and multiple — stresses in her life in one of two ways: Curling up in a fetal ball and crying, or screaming at the top of her lungs. Sometimes, when you’re lucky, you get both in a span of just a few minutes.
Medication has helped mask those emotions, but over time, as she has gotten older and moved into her teen years, Kate is no longer comfortable with the mask — on or off.
That leaves us with a mix of hope and dread. As her parents, we hope and pray that she is doing better, that something — in this case hospitalization — will help her to be better. Dread comes from experience, because we know that when she is positive that the other shoe is just waiting to drop.
It’s interesting, because in our marriage, I’m almost always the one who takes the “glass is half full” view. Consider it Paul McCartney’s “getting better all the time” combined with an occasional “can’t get much worse” from John Lennon.
And remember, neither was as good solo as they were together.
With Kate, Jill usually takes the optimist role. My view is that we should not question why, but determine how best to deal with a 48-card deck that is missing several essential cards right now. This focus on analysis and solutions helps me to understand our daughter, but doesn’t work that well at times in the moment when things are fired up.
Jill is more patient and better able to relate to her than I am. She frets and continues to search for solutions. For the longest time, she had difficulty accepting the fact that this is a long-term illness with no short-term resolution for our daughter’s condition, that she won’t be “normal” (whatever that is).
In her view, this shouldn’t happen to a child.
She’s right about that, no question. But it has.
••••••
Every time a new drug was introduced, or the dosage increased, Kate always seemed to get a small bump. The family breathed a sigh of relief, only to learn that it was just temporary. As she entered adolescence, then puberty, then middle school, even the effects of the pharmaceutical bumps lessened.
For the last several months, nothing has worked.
We have been very honest with Kate about her situation, and have tried to explain what it is to her in positive — yet truthful — terms. Our family’s firm belief is that treating a brain disorder is no different than treating, say, diabetes (both have a biological basis). Mental illness should be discussed in the same matter-of-fact way that we discuss any long-term, physical disorder.
The difference, however, is that treating bipolar, ADHD, and other types of these disorders is a crapshoot. What works for five people with the same diagnosis won’t work for numbers six through 10 because each person’s brain chemistry is unique. Since, according to CABF, the adult brain is not fully formed until age 25, treatment becomes even more of a shot in the dark with children and adolescents.
Research also shows that girls tend to linger longer on the depressed side of the bipolar pool. Most bipolar medications on the market are more effective for mania than depression, which can make treatment difficult. Hospitalization or a stay in a residential facility often is the only effective way.
We love our daughter, would do anything for her, and have tried everything to help. But “It” has refused to leave Kate — and by extension her family — alone. Progressively, we have become worried about her increasingly fragile mental state, and the anger that lies underneath. Physical and emotional safety, hers and ours, is an ongoing concern.
••••••
Bipolar is an octopus, metaphorically speaking. It is not self-contained; if anything, it demands to always be the center of attention. You can tiptoe around a mood disorder all you want, but it still will strike out, often for the most miniscule things at the most inopportune times. Think of it this way: ’Roid rage has nothing on an ill, pissed off 14-year-old girl in a very dark place.
This makes for a difficult family dynamic under the best of circumstances. And the past year and a half has been trying, as we juggle careers, teenagers, and commuting back and forth from Virginia to New York.
Kate knows her internal spin cycle has been out of control. She no longer thinks her psychiatrist is effective and wants someone different. We’ve known her current mix of meds wasn’t working; in fact, her new doctor said her ADHD could have been misdiagnosed. After the twitching/convulsive episode last week, she begged us for help, saying she knows something is wrong.
That’s what we’ve been dealing with for the past 10 days, and we’re hoping that we’ve got her medication sorted out — for now. Still, through individual and family counseling, other issues must be addressed as she works to find that elusive emotional equilibrium.
In general, girls tend to internalize their emotions. Kate has suppressed hers for so long that the only way they know how to come out is in a rage. She has to be able to identify when she is upset or unhappy and learn how to deal with it. She has to learn how to be accountable for her actions — in school and at home.
The problem is that she speaks in general terms, too general really, if she wants help. The art of in-depth debate and conversation, something that brings me great joy in this life, escapes her because she has no patience for it. And her coping mechanisms are so deep, so embedded, that it will take a very long time for her to find new ones.
There are no magic wands. That’s for sure.
••••••
Jill and I genuinely believe Kate wants — desperately — to be positive about life. But a fake positive has the effect of a false negative; no one wins. We have to work together to identify ways for her to have positive interactions with her family, a lesson that she can hopefully translate into friendships with her peers.
At times, I provoke the situation with Kate, in part because I know that the only way she will stop pressing me — for food, for money, for stuff — is to make the emotional valve go off. That is not healthy parenting; I need to do better.
I can’t imagine what it is like to be in her skin and to feel so uncomfortable all the time. I can’t imagine what it is like to feel like you can’t be alone, or that you must be doing something — anything — at all moments of the day.
The counseling sessions we’ve had this week were about unmasking the real Kate. So far, they have not been terribly successful, although the medication adjustment has helped. What has emerged, however, is how important her ongoing treatment is. Chiseling away at something that is so engrained — taking apart to put back together — will take time.
How long that will be, no one knows. I just hope we can all stay on the right path.
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