Benedict Euer, O.S.B
Volume 28 Number Two Summer 2007, PAGES 28-32
Bipolar Disorder is a mood disorder originally called manicdepression that characteristically involves cycles of depression and mania. Sometimes the mood switches from high to low and back again are dramatic and rapid, but more often they are gradual and slow, over weeks or even months, and intervals of normal mood may occur between the manic and depressive phases of the condition. The characteristic symptoms of both the depressive and manic cycles may b e severe.
Both phases of the disease are deleterious. Mania affects thinking, judgment, and social behavior in ways that may cause serious problems and embarrassment. For example, an inflated sense of self-importance, increased talkativeness and flights of ideas or racing thoughts may take place when an individual is in a manic phase. Depression can also affect thinking, judgment, and social behavior in ways that may cause grave problems, such as a depressed mood for most of the day, almost every day, a loss of interest or pleasure in almost all activities, almost every day, and feelings of worthlessness or excessive feelings of guilt, to name but a few. Bipolar Disorder also elevates the risk of suicide.
According to the DSM-IV-TR, a diagnosis of Bipolar I Disorder requires one or more manic or mixed episodes. The current or previous course of the illness may include hypomanic and depressive episodes also, but the diagnosis of Bipolar I Disorder requires only one manic or mixed episode. A depressive episode is not required for a diagnosis of Bipolar I Disorder, although often people with Bipolar I Disorder suffer from them as well.
Bipolar II Disorder, the more common but by no means less severe type of the disorder, is characterized by episodes of hypomania and disabling depression. A diagnosis of Bipolar II Disorder requires at least one hypomanic episode. This is used mainly to differentiate it from unipolar depression that has no manic episodes.
About 5.7 million American adults, or about 2.6 percent of the population aged 18 and older, have Bipolar Disorder. Although Bipolar Disorder often worsens over time if untreated, most people with it can achieve stabilization of their mood swings and reduction of symptoms with proper treatment. Treatment usually consists of medications known as “mood stabilizers.”
When I joined a religious community at the age of thirty-six, I did not know I suffered from manicdepression or Bipolar Disorder nor did my community. Since the age of fourteen, I had suffered from bouts of highs and lows, but just considered them part of my life, a cross I had to bear. I had had a successful career as a high school teacher. In the schools I taught at, I was just considered an enthusiastic teacher. I used the summers as a time to regenerate and overcome my black moods of depression. Luckily, the summer vacations were sufficient when I was in my twenties and thirties to rejuvenate my spirit so that I was able to return in the fall as the same “outstanding” teacher who had taught the previous academic year.
At the age of thirty-six, when I entered the religious life, I felt it was only a new approach to what I had been doing up to that point. All my teaching had been in Catholic schools. I had attended Mass most of my life on a daily basis. I had tried studying before for the priesthood in the minor seminary, but had left. I had matured by my thirties or so I thought, and now was the time to fulfill my dream of becoming a monk and a priest. I took all the tests, although at that time they were not as many as today, talked to the Vocation Director, and appeared to be suited for the rigors of the religious and monastic life.
When I entered the community, I was the only novice. Nevertheless, the community still had in place all the rules and work as when there were seven novices. The challenge was formidable. I was thirty-six and alone in a novitiate designed in the 1940s or earlier. The rule was still blind obedience. On the surface it would appear that such a setting would not work for a manic-depresive. But for a person who has Bipolar Disorder structure is life saving, literally. As one of my psychiatrists later told me, “Monasticism saved your life. You should be dead from either suicide or alcoholism.” My community at the time knew nothing of this.
I had a few minor breakdowns during my novitiate but no more than I had had over the years. At fourteen, for example, I had an undiagnosed “nervous episode,” where I was barely able to function, but it went away apparently by itself. A similar episode occurred when I was eighteen years old. I entered a novitiate where I lasted six months and went home. I also had an episode in my sophomore year of college when I became sick and was unable to attend class for a week. When I came back and continued classes, however, I received mostly “A’s.” When I started my career as a teacher, I experienced the ups and downs that a bipolar person has, but summers still seemed to remedy the dark nights of my soul. And the novitiate was God’s territory. So I offered everything up. I had one time during the novitiate where I lost control. It was at Christmas when no one helped with most of the preparation. Christmas morning I was so exhausted that by early evening I had to go to bed. As often happens in community, no one noticed.
After my novice year, I was sent to the seminary. I had a scholarship that paid all my tuition, and the Abbot had warned me that the community needed this financial help. As a result, I felt I must keep the scholarship, or I might not be able to continue. I entered my training with trepidation for I had to keep a 3.75 average or better. I threw myself into my studies and did nothing else. The first semester I got a 4.0. I continued to pressure myself, until one day one of my confreres said, “You know if you die tonight, the community will not put your grade point average on your grave stone.”His statement pulled me back into reality, and after that thing s seemed to go much b etter.
Ordination and the first years of my retur ning to teaching went extremely well. I was able to hold my head ab ove water as more and more duties were placed on me. As is said in most relig ious communities, “If you do a job well, you will get more and then even more to do.” I was chair man of the English Department and taught four classes of Freshman English. I was Director of Vocations as well as Director of Admissions. I kept the full monastic schedule while having two evening study halls, did par ish work on weekends, and every other week had daily Mass at other locales.
After five years of working at that pace, I started to break down. Once again no one noticed. I was good at hiding my ups and downs for I had years of practice. In the summer, I started to ride my bicycle twenty or thirty miles a day. It helped until I became manic about that as well.
As time went on, however, I started to fall into deeper depressions followed by periods of mania or vice versa. No one noticed because I did not find this pattern of behavior strange. It is not unusual for Bipolar Disorder to go undiagnosed by both the people who have it and those who live with them. I just thought it was normal. Eventually I totally burned out at my first monastery, and then went to a second one where I was made Director of Campus Ministry. The second monastery did everything to accommodate my illness that still had not been diagnosed. As time went on it became more and more evident not only to the community but to myself that I needed help. I had become an associate professor of Education and was now tenured, but I kept doing more and more. It was as if I had to prove something even though the Abbot kept telling I did not.
I spent a year in England resting, studying, and recuperating from burnout. When I returned, however, I fell into the same pattern. Finally, when I was sixty years old, the Abbot, speaking for the community, asked me to see a psychiatrist. I agreed. And the rest is part of my personal history. In fifteen minutes, the psychiatrist diagnosed me as having Bipolar I with Post Traumatic Syndrome (PTS). I sat there relieved, for I finally had a name for what caused me to act the way I did. But the name alone did not ascertain the cause of my manic depression for the causes are multiple, a combination of chemical, genetic and environmental factors that trigger a Bipolar Disorder. Other members of my family suffered from depression, alcoholism was evident in the paternal branch of my family, and I lost my father when I was eight years old. All played into the triggering of my Bipolar Disorder. Immediately I was put on medications that helped control my mood swings. And with my new found understanding of my disorder, I have been able to change many if not all the patterns of behavior that are caused by manic depression in my life. I openly acknowledged this illness to the community, and I have worked toward controlling it ever since for I realize there is no cure for manic-depression. In the end, because of their awareness of my illness, members of my community have noticed the change in my behavior.
Although I put both of my communities through hell over the years, I was a very functional member of the community. At times, I did well. At other times, however, I was short-fused, suffered from moodiness or was totally exhausted from insomnia. But no one seemed to notice these behaviors, or if they did, no one confronted me on them.
HOW TO HELP—7 RECOMMENDATIONS
With my story told, I would now like to suggest some remedies for communities with members who suffer from Bipolar Disorder. You may not know who they are, but you may suspect the presence of problems. More importantly they may not know they have Bipolar Disorder, just as I did not know until I was sixty years of age. Nevertheless, more often than not, the person knows there is something wrong.
First, I would recommend that the community look for the symptoms. For example, moodiness, depression, and episodes of “the blues” lasting for long periods of time are danger signals. Complaints of insomnia, inability to sleep, or reported decreased need for sleep may also be signs of Bipolar Disorder. Another warning sign may be rapid, pressured speech, often marked by a person’s stumbling over his/her words. Still another indication is the ability to complete large-scale projects in a surprisingly short amount of time. For example, I wrote my doctoral dissertation, 26 0 pages, in three weeks. The Director of Campus Ministry observed this but could not believe it. She had a husband who was manic-depressive, but was afraid to suggest to me, a priest, that I was ill, especially mentally ill.
Second, in the Benedictine order, we have what is called “senpectae,” members chosen to confront a man who has a problem, such as excessive alcoholic consumption or temper tantrums. The senpectae are chosen because they are gifted in the area of confrontation or because one may b e a friend who has the person’s confidence. These persons will try to win the monk over to the need of seeking help. This is a fifth century version of an intervention. St. Benedict was a wise man in more ways than one.
Only at age sixty, when I was totally exhausted, did someone confront me. Burnout is a factor that may contribute to episodes of manic-depression. It was those episodes of total burnout that gave the community a sign that I might need more than just rest or time away. My second community always was there for me. When I was burnt out, the Abbot would always ask, “What would you like to do?” And I would say “I would like to reduce my load.” Although I was given permission to do so, I failed to recognize that I was dealing with a symptom, and not the cause. It wasn’t until I was repeating the episodes that members of the community went to the superior and told him I needed help. At that time, the Abbot intervened, and I was ready to accept his advice. Would I have been ready at an earlier date or age? I do not know. It is a question that remains unanswered, but I knew something had to b e done when I reached the end of the proverbial rope.
Third, the community should have a professional lined up for the member to see. The statement, “I think you should see someone,” throws the member into an abyss of not knowing what to do or to whom to turn. My community had a psychiatrist in mind; thus, I did not have to go to the phone book to try to find one. I could pick up the phone and make an appointment. I could have said I would prefer another, and that would have been no problem. All the community wanted was for me to see someone. I needed help and they knew it. By that point, I did too.
Selecting a psychiatrist is like trying to find a spiritual director. Many are called, but few fit the bill. I worked with my first psychiatrist for two years. A “recovering” Catholic who knew how to listen and knew the terminology of the Church, he did not say to me “The only cure is to leave your community.” He started me on medication. He believed in creating as he said, “the right cocktail” of medications. He was not an expert in the treatment of Bipolar Disorder, however, and eventually, I knew I had to seek another psychiatrist when he was spending most of our sessions talking about his problems with me, the priest.
The community should anticipate that a member might possibly change doctors two or three times at the least. The most important role of community is to be supportive of these choices. Sometimes the simple question “Why?” is enough to elicit the reason(s) why the person is changing psychiatrists. No matter what the person’s response, the question is valid and should be asked. When doubts are raised, invite the superior to talk with the new psychiatrist. I have never feared communication between my Abbot and my doctor. The founder of the Order of St. Benedict said, “There should be no secrets between the Abbot and his monks.” I believe that wholeheartedly. If there is something I do not want shared among the two, I will tell my psychiatrist. But questions about work load, medications, what I need, and other questions are all valid points for discussion.
Fourth, a second opinion is never bad. Last year, just to check that everything was fine, my Abbot asked me to go to the St. Luke Institute in Maryland. I must admit I was taken aback by this request and at first balked. But then I realized this was for my good. My psychiatrist also thought it was a good idea. I came back reaffirmed that what I was doing was right. My medications were fine. The testing only reinforced what I was doing. And more than anything else I realized I was controlling the illness, and that there was no cure. My stay at St. Luke proved the good intentions of my community and their care and concern for me. Fifth, the superior and the community should never feel “cowed” or held hostage by the person suffering from Bipolar Disorder. Bipolar Disorder is an illness. If a memb er of the community had cancer or diab etes, the memb ers would afford that person all the medical help that the person needed but not allow that person to dictate how the community should act or what they should eat. Sometimes the person with Bipolar Disorder has to b e told that his/her actions are inappropr iate. Mood swing s do not g ive a person permission to speak harshly or to attack a person inappropr iately. Sometimes like a child in g rade school, a person with Bipolar Disorder has to b e told how to b ehave or g iven a time out. Dur ing a manic episode, a person with Bipolar Disorder sometimes speaks b efore thinking; the end result can sometimes b e disastrous.
Sixth, the bipolar person can add much to a community by his/her talents, creativity, and intensity. The emotional balance now accomplished by the use of medication is phenomenal. I still feel creative and write poetry on a regular basis. If the community member takes the medicine prescribed by a psychiatrist, the person will likely be able to function quite well, often as they did before without the extremes of behavior that were symptomatic of their disease. I often wonder what would have happened if at age fourteen I had been diagnosed. Recently I gave a talk to a class in psychology and talked about my Bipolar Disorder. I expressed the wish it had been diagnosed at an earlier point in my life. One of the ladies in the class raised her hand and said, “But if it had been diagnosed when you were fourteen, there would not have been the drugs available that there are now.” So true. God works in strange ways.
Seventh, mental illness is not something to be ashamed of by either the person receiving care or the community to which the person belongs. When I was a child, no one went to a psychiatrist. It was a disgraceful thing if one did. Today visiting a psychiatrist or therapist is only using the resources that are available in the community in order to live life more fully and normally.
In conclusion, this article has tried to describe Bipolar Disorder from the perspective of the person who has it, namely myself, and the response of the community in which that person lives. Sadly, a person who suffers from Bipolar Disorder wants help, but often is afraid to ask. A religious community must work with the member in order to rectify the situation so the member may become a more fruitful member of the institution.
One question that arises is “Should a person withBipolar Disorder be accepted into a religious community?” Naturally this is a multi-layered question. Has the person already suffered institutionalization? Is the person unwilling to accept his/her diagnosis of Bipolar Disorder? Does the community insurance cover the costs of medication and hospitalization? As with any decision, no community knows what will happen in the future. Is this disorder something the community is willing to deal with, and if so how? Questions of this sort would be better addressed in another article. This one deals only with those who are already members of a community.
It is my hope that these suggestions, coupled with my own personal story, may help religious communities deal with a member who suffers from Bipolar Disorder. Both the community and the person who suffers from this illness are confronted with challenges. I believe that a religious with Bipolar Disorder may be an asset to a religious community if only both sides, community and the person, try to understand the illness and work toward maintaining a balanced and structured life that assures stability for both community and religious.