…continued from Saturday.
From the time I finished high school until I finished graduate school, I spent most of my summers as the horsemanship director of a Christian summer camp in central Oregon. One summer a coworker brought her horse to camp, a young, fiery-tempered gelding that she wanted to work with and eventually use as a mount for campers. We soon discovered that he had a unique problem.
For no apparent reason, the horse would suddenly stand stock-still and begin to quiver all over. He would drop to his knees, fall over on his side with a grunt, and proceed to thrash wildly—legs flailing and head twisting from side to side. After several minutes of mayhem, he would gradually cease his contortions, roll back on to his knees and heave himself up into the standing position.
For at least twenty minutes after an episode, he would walk gingerly around his stall or the corral, shaking his head and nickering inquisitively. I always thought he looked a little shocked. His behavior bewildered and confused us. Up until this incident, he had acted like a normal horse.
The first time it happened, I felt certain he suffered from colic, but since the episode didn’t digress into a full-blown medical emergency, I figured I must have misdiagnosed him. The second time it happened, the camp doctor witnessed the event.
“I’ve never seen an animal have a grand maul seizure!” he exclaimed.
“A what?” I asked.
“That horse suffers from epilepsy,” the doctor explained. “The seizure happens when his brain experiences a storm of electrical activity, causing things in his brain to misfire.”
We decided to not let campers ride the horse, regardless of how he progressed in his training. Over the course of the summer his owner had to bail off him a time or two when he had a seizure out on the trail. I always felt sorry for him—especially because he looked so dazed, confused and embarrassed when he stopped seizing.
The gradual fading of hypomania stretched out over weeks. In the meantime, we could only pray that if God wanted Sarah in Alaska, he would make it possible. Sarah did her part by remembering to take her new medication and keeping her appointments.
I could tell by the little things—the way she handled conflict, the way she made a conscious effort to use her phone in moderation, and her willingness to exercise—that the real Sarah had staged a comeback. Of course, after almost three years of struggles, we had all forgotten the ‘real’ Sarah. At times, she too, seemed unsure of who she really was. As we spoke about things that had happened during her manic cycle, she expressed remorse and regret and disbelief over her actions. She expressed deep confusion over how in the world she had ever thought that the things she had done could have seemed ‘normal’ to her.
I believe the cutting incident expressed a desire to pay penance for what she had done while manic, and because she still suffered from hypomania, it made perfect logical sense to her.
Some people may think that bipolar disorder is simply an extension of a person’s normal highs and lows, and that with therapy and self-awareness a bipolar person can avoid depression and mania.
Modern research does not agree. According to Dr. Jay Carter, Doctor of Psychiatry and author of multiple books on bipolar disorder, the prefrontal lobe of our brains develops last—and the information stored there leaves us first as we age. The prefrontal lobe acts as our moral filter, and it doesn’t fully develop until late adolescence. As a person ages, the wisdom of the filter slips away and a person loses the ability to think with ‘insight, hindsight, and foresight,’ according to Dr. Carter. In other words, irrational things look rational and a person loses the ability to see the consequences of one’s actions.
Dr. Carter explains that physiologically, a storm of activity in the prefrontal lobe causes mania. A person will experience racing thoughts that seem to knock out logical thinking by their sheer volume. Mania convinces a person that they don’t need sleep (and one of the corresponding problems with sleep deprivation is the loss of executive function).
After the mania, Dr. Carter explains, the prefrontal lobe takes a vacation for 6-8 weeks. He calls this the “temporary lack of executive functions.” According to the Center on the Developing Child at Harvard University, executive functioning and self-regulation skills:
“are the mental processes that enable us to plan, focus attention, remember instructions, and juggle multiple tasks successfully. Just as an air traffic control system at a busy airport safely manages the arrivals and departures of many aircraft on multiple runways, the brain needs this skill set to filter distractions, prioritize tasks, set and achieve goals, and control impulses.”
Only now, as I further study bipolar disorder, do the things that Sarah did (especially whilst manic) make any sense to me. For a long time, I blamed myself and my parenting style for her bad decisions. After all, our goal as parents had been to raise godly children who understood the difference between right and wrong—and Sarah’s manic behaviors showed a blatant disregard for anything we had ever tried to teach her.
Bipolar disorder, like epilepsy, has a physiological basis and rational explanation. Just as that epileptic horse could not control when and where he might succumb to a grand maul seizure, a person has no choice over whether or not they will experience a storm of activity in their prefrontal lobe which results in a manic episode. When the mania subsides, a person will often fall into a pit of depression as their executive functioning goes back ‘online’ and they experience guilt and regret over their behaviors.
A week before her scheduled departure, the psychiatrist finally gave the green light for Sarah to go to Alaska. She made arrangements to meet with the psychiatrist over the summer via Skype, and made sure that she would have access to a nearby clinic for the monthly blood draws (to ensure that her white blood count stayed normal).
Pedro worried that Sarah would end up getting fired her first week on the job, and I worried that something might trigger another manic episode. But deep down, I knew that God had arranged everything for her and he would use the situation as a time of rest and healing for Sarah.
…to be continued.
Linking up with my friends Jennifer Dukes Lee, Holley Gerth and Sarah Frazer today.