I don’t remember when she began to change. It might have been somewhere between 15 and 16 years of age. Until then Pami was the sweetest, kindness and most loving child anyone could ever hope to have. The oldest of five, she fawned over her younger siblings, caring for them as is if she were their mother. Smart, beautiful, animated and talented, she won the hearts of everyone she met. She adored her grandparents, all four of them and her essence was boundless. I am not sure when the signs actually appeared. It was not sudden, but rather subtle and gradual. By 16 she lost her innocence and gradually became rebellious and difficult to handle. I thought she was just going through the developmental stages of the teen-age years, flexing her autonomy and independence. It was much more, but not knowing or having any insight to mental disorders at that time, I attributed it to adolescence and hormones.
If you notice changes in your child’s behavior, beginning around puberty, this blog is for you. It’s not just the Internet, bullying, drugs or peer pressure that may be the culprit. It is true they may be contributing factors to depression and anxiety; however, it may be the beginning of bipolar disorder emerging insidiously without any warning or any of the above causative factors. These two disorders, depression and bipolar disorder are common in early adolescence, although difficult to diagnose as there is so much comorbidity. Mood shifts are normal due to chemical changes in the body, with the onset of hormones. It is normal for young teenagers to become defiant, hostile towards their parents, seeking an identity or having an identity crisis. It is normal for moods to suddenly shift from a sense of joy to a flat affect, sadness and even anger for no apparent reason. Chemical changes in the body produce these symptoms and it is all normal and part of the development stage they are going through. However, it may not be the usual and customary fluctuations due to transitional growth and development. There may be a hidden, unsuspecting diagnosis deep beneath the surface, juxtaposition to adolescent development. It takes many years for a differential diagnosis to be made. Bipolar disorder has many of the same symptomatology as some personality disorders and schizophrenia. In the case of my daughter, it was not until the mid-twenties that she had her first breakdown, but still no differential diagnosis until her early thirties. By that time, it was too late for treatment. Her delusionary system stood in the way of treatment, thus causing her to reject medicine and therapy. She believed the medicine and psychiatric treatment were undermining her well-being. Her belief system interfered with any and all treatment. Pam believed that the devil was going to take her soul. She believed that she had been chosen to be the intermediary between God and Lucifer. No rationalization, no counseling, no therapy would convince her otherwise. Her hallucinations, both visual and auditory outweighed any logic or reason.
Bipolar Disorder I is a different diagnosis that Bipolar II. Bipolar II can be successfully treated with both therapy and medication. Pam had Bipolar I, a far less treatable disorder due to the delusionary system occupying her brain. Once her belief system had been created, there was no reasoning, no medicine and no cure. She was doomed by her mental illness and it became her executioner. Pam would have never chosen suicide if she was in her right mind. She never would have left a legacy to her father and I, nor her siblings. Pam loved life. She lived life to the fullest before her disorder took over. All the king’s horses and all the king’s men couldn’t put her back together again.
There was no cognitive choice except leaping out of her father’s 15th story window. I will never know why she jumped; what went through her mind and what caused her to make that choice. Surely, I know she was not aware of her actions. There wasn’t a sound heard as she plunged onto the concrete beneath that window. She died in the trance that began before she leaped.
Katie was 15 years old, a sophomore in high school, head cheerleader and extremely popular with all her classmates. Her mom came home one day after her tennis game to find her daughter hanging from the oak tree in their back yard. Whatever possessed Katie to take her life is still a mystery to the family and all who knew her. Underneath Katie’s bubbly personality, shrouded in the dark, was a clinical depression that loomed daily for more than a year. She lived in a silent world unknown to everyone. Not even her best friend, nor her parents suspected she was in danger. Since Katie never had any professional help, a cause would never be determined. Depression is part of bipolar disorder. The cascade of emotions that follows a suicide can become what is known as complicated grief. It’s been almost 10 years and her family are still grieving. Never having had a clue that mental illness permeated her every mood and thought created guilt, anxiety and depression to the survivors.
Mark had just turned 18. He was excited about attending the college he had chosen as his first choice. He had some altercations with some of his high school teachers and bouts of contentiousness with a few of his close friends. His parents were worried about his sudden aggressive behaviors, foreign to his usual compliant and mellow state of being. They assumed his oncoming move from the family home and the unknown future of college made him anxious. They talked to Mark several times trying to understand his feelings and help him work through his anxiety. He always denied being anxious and tried to convince them that they were struggling with his impending leave from home. Being the baby of four children and the last to leave the family home, he tried to allay their fears by suggesting they were just struggling with “the empty nest syndrome.”
Mark’s mother was still uncomfortable with the changes she saw in Mark’s moods and behavior. He could be calm and pleasant and within minutes morph into paranoia thinking and inexplicable rage when she tried to talk with him. His responses frightened her and she asked him to see a counselor before leaving. He was not agreeable but finally conceded after she convinced him that she would feel better after a visit. His visit proved to be fruitless as the counselor did not seem concerned. Mark put his best foot forward and convinced the therapist that he was fine aligning and projecting the blame on his mother. The counselor felt Mark’s behavior and mood swings might be attributed to the upcoming changes in leaving home and going away to college. Mark’s choice of school would take him more than a thousand miles from his home.
As the months passed, Mark made friends and adjusted to his college life. He pledged a fraternity and enjoyed the comradery of his fraternity brothers. Mark appeared to adjust well to his new environment and classes. His first trip home was Thanksgiving. The entire family joined the festive holiday and Mark seemed normal and excited about sharing his new life with everyone. There were no signs of any depression or anxiety.
Mark returned to school after Thanksgiving giving no clues to anything bothering him. His moods seemed stable and he appeared well adjusted to college life. His mother abandoned all her fears and soon Christmas would bring Mark home again to celebrate the holidays. As soon as he returned there was a marked change in his moods. He seemed detached and sullen. He didn’t seem interested in participating with the family functions, preferring to stay in his room. It was obvious to both his parents that he had disconnected from the family and became more isolated than the previous month. Once more she asked Mark to see the counselor. He became contentious stating that he was fine and refused to make an appointment. As the time passed, his behavior seemed more and more distant and ornery.
In just two weeks after Mark returned to school, his parents received a call from his fraternity big brother.
“I think you better come and check on Mark. He doesn’t seem normal.”
Concerned, his parents made plans to visit Mark at school. He was angry that they came to check on him, feeling that they didn’t trust him. He stated vehemently that he was fine, although he looked disheveled and unkept.
“Why don’t you take some time off from school and come home to rest and see the counselor once more” his mother asked.
There was no compliance or agreement to do so.
“I’m fine! Please stop worrying about me. I am not coming home!”
Mark’s parents left with a great deal of discomfort, but there was nothing they could do to convince him to come home. He was adamant and unwilling to change his mind.
A few weeks later, his parents received a call from one of his fraternity brothers that Mark had shot himself. There was no note. His fraternity brothers had called the police as soon as he was found on the floor in his room. His parents were in shock and grief from his inexplicable suicide.
Mark had never received a diagnosis. He had not been in therapy long enough to be referred to a psychiatrist, so without a diagnosis, no medicine was prescribed. It might have been a clinical depression that had been disguised or bipolar disorder that went undiagnosed. Without treatment, no one was aware of how fragile he was.
In my book, WHY DID SHE JUMP? My Daughter’s Battle with Bipolar Disorder, with searing honesty and reflective insights as a mother, single parent and a professional, I chronicle her struggle with mental illness and the impact and grief it had on our family. Pam, Katie and Mark are just 3 of thousands who have lost their lives to suicide because of bipolar disorder and depression. The statistics are staggering. Suicide is the second-leading cause of death among people age 15 to 24 in the U.S. In the twenty-five years since Pam’s passing, no significant changes have been made in our substandard health system to help the victims of mental illness. We must raise the standards to support the mentally ill by providing long term treatment instead of a 24–48-hour Baker Act admission or a short-term hospitalization.
WHY DID SHE JUMP? (My Daughter’s Battle with Bipolar Disorder) can be purchased on Amazon.com under books.