Odyssey of madness

Hillsborough man publishes journal written while battling bouts of manic-depression.

By: Minx McCloud
   At the age of 26, Hillsborough resident Casey S. Madison (not his real name), now 39, began an odyssey he could not have foreseen.
   He was diagnosed as being manic-depressive, synonymous with the newer term, bipolar disorder (BPD). Soon, he found himself living in a nightmarish world of delusions, paranoia, and bizarre behavior.
   His experiences and observations of everyday life led him to write a book of poetry titled "Portraits of Madness," which was published in 2004. On the cover, its content is described as "poetry written by a manic-depressive while off his medication."
   It’s a book filled with wild, bizarre, brutal — yet often beautiful — imagery.
   "Manic-depression is a recurrent and serious mood disorder characterized by mood and behavior extremes," said Andree Nolen, a psychiatric nurse practitioner at the Center for Psychological Services in Hillsborough. "(The condition includes) unpredictable mood swings, depressive episodes, irritability, euphoria, impulsiveness and recklessness."
   According to the National Institutes of Health, more than 20 million adult Americans will be diagnosed with some form of mood disorder, the classification of mental health diagnoses which includes bipolar disorder along with mild and major depressions, in any given year.
   BPD can run in families, and an early diagnosis is beneficial.
   And while manic-depression is one of the most common mental illness diagnoses, when untreated, it can spiral out of control. It is also often accompanied by other mental health issues, sometimes leading to violence — even murder and suicide.
   "I’ve learned from experience that manic-depressives seem to make bad, bizarre and spontaneous decisions leading to self-destruction with no regard to the consequences," Mr. Madison said. "You’re either going 5 mph or 100 mph. — there’s no in between."
   Throughout high school, Mr. Madison had had the normal emotional fluctuations of teen life, but college was a whirl of parties, and he became a binge drinker at an early age.
   "I fell into the wrong crowd," he said. "I was always a bit of a rebel and had behavioral problems. It was very taxing for my parents."
   After college, he worked as an emergency medical technician (EMT) and "seeing so many injured and terminally ill people really started to wear on me."
   That was when he began having violent episodes.
   "My first bad delusional episode was when I didn’t sleep for two days and I was paranoid that people were after me," he said. "I locked myself in my room, and had my first suicide attempt by swallowing pills, which shortly after, I realized was wrong. I threw them up."
   One night, he thought people had broken into the house and were coming to kill him. He became violent and afterward, his father had him placed into psychiatric care.
   The anti-psychotics prescribed made him more clearheaded and he was soon released. Another time, he was feeling fine and stopped taking the prescribed medications. Soon, he was in an irritated manic state, and became incoherent while talking to his brother, who grew increasingly afraid.
   "I believed he was against me so I shoved him across the room," Mr. Madison said. "He forced me out of his room and locked his door. Now I was outside his room, and in a brief moment of rage, kicked the door … and broke it down."
   Scared and shaken, they both had a moment of clarity. After an apology and a long talk, Mr. Madison and his brother both decided he needed help and dialed 911. The police showed up and took him to a local hospital’s psychiatric ward.
   Over the years, Mr. Madison has been institutionalized six to eight times, he estimated, though he admits his memory can be a bit vague.
   "I have a nonlinear mind and it’s hard to put things into chronological order," he said.
   One might wonder why someone who was improving from prescribed drugs would go off those medications.
   Quite simply, Mr. Madison felt better.
   "I ‘self-medicated’ with drugs and alcohol," he admitted. "I liked to party and I didn’t feel any real psychosis coming on.
   "Stick to your medication," he advises others with BPD. "It takes awhile to find the right mix of meds. Don’t be satisfied with partial health or minor improvement."
   It’s good advice — the NIH notes the frequency of patients, especially men, to stop taking medications once they begin to be effective.
   But once patients drop off their medication, they can soon begin spiraling out of control in a new episode.
   "Each new mood episode appears to kindle the brain for more frequent and more severe mood episodes in the future," Ms. Nolen said. "BPD treatment needs to be early, aggressive and consistent."
   She added that treatment includes both psychopharmacology and psychotherapy. When treated aggressively BPD symptoms and occurrence rates can be reduced.
   Interestingly enough, according to Ms. Nolen, BPD may take years to be diagnosed since most people seek help for their depressive rather than their manic or hypomanic episodes.
   "According to some estimates, up to 80 percent of patients who are eventually diagnosed with BPD are diagnosed or treated for another diagnosis first, such as major depression or ADHD," she said.
   Mr. Madison does not want to see others go through what he has experienced. He advised patients with BPD to stay away from alcohol and street drugs, though he admitted regretfully that alcohol is still one of his "demons" and he still "slips" sometimes.
   Although he maintained that he is at peace with himself mentally, he is dismayed at the fact that years of drugging and drinking have damaged his kidneys and liver. He is unhappy about the fact that the very medications that control his manic-depressive states have caused him to gain weight.
   "It’s a cruel joke. My mind is clear but I’m in bad shape; I’m deteriorating." He smiled ruefully. "I guess sometimes you trade one thing for another."
   He said that his major demon, even more than alcohol, is having delusional episodes.
   "It’s like being in another dimension of time — a living hell," he said. "It puts other people through hell, too."
   He has not suffered major delusions for quite some time, but when he does have moments of rage now, he said, he works out his anger on a heavy punching bag. He’s also a student of Asian Zen and describes himself as a "complete martial artist."
   He described his illness (when not controlled) as a manic, reckless euphoric feeling, often followed by deep depression. Sometimes he is not sure which is worse — the out of control feeling he gets from being manic or the flat empty feeling he gets when depressive. Another reason medication is so important.
   "I think sometimes men tend to go off their meds because they don’t want to admit they need help or direction," he said. "They need to feel in control of the situation, the strong figure, not vulnerable."
   "People experiencing euphoric mania might feel they have a brilliant business scheme, can do without sleep, and may act recklessly like driving fast, charging thousands of dollars on credit cards, quitting a secure job," Ms. Nolen said. "Others with mixed episodes may flip-flop between highs and lows all day, experiencing their moods as unpredictable and rapidly shifting. Persons who experience hypomania tend to feel the highs as feeling energized, great or irritable, feelings that are often followed by severe and disabling depressions."
   Mr. Madison said he thinks it took him about two years to write the book, but "time just blurs together."
   "I had no choice but to write the book. The mania possessed me to write down all these images. At the time, I was an alcoholic and addict, with racing thoughts and ideas. It was a catharsis."
   Although he said he can still write, there is not much of an urge to do so anymore. "I kind of stated everything I wanted to say."
   He was unable to find a publisher at first, and finally made the decision in 2004 to self-publish the book through Professional Press. He said he had the support of his family and friends all along, and is grateful to one of his brothers for critiquing, typing, and editing the work. It is now listed at Amazon.com, which is an accomplishment in itself.
   "I pulled my poetry out of everyday life," he said. "Some poems were inspired by delusion, but I was not necessarily delusional when I wrote them. However, I was manic."
   He welcomes comments on his poetry, which can be forwarded to him through the Hillsborough Beacon Web site, www.hillsboroughbeacon.com.
   "When you read a poem, it should be like looking at a painting," he said. "Many times the reader knows more what the book is about than I do. Whatever meaning you get out of the book is what it means. I’m not trying to force an opinion — I am just putting the image out there."
   Mr. Madison continues his challenging journey to wellness, hoping his story will be beneficial to others.
   
For more information on manic depression, bipolar disorder or any mental health issues, contact the Richard Hall Community Mental Health Center, 500 N. Bridge St., Bridgewater, or 908-725-2800.