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21 and Bipolar: An individual case study.

Billy Bob Thornton. That’s the name that “Billy” wanted me to call him when I first approached him about doing this article. I asked him why, and his response was, “I just like that name.” (He’s never seen Sling Blade.) I have to admit that I was a little hesitant about asking him for an interview even though I’ve been his mental health counselor for almost two years now. A lot of people who suffer from mental illness don’t like to discuss it, much less share their experience with the world. I see him three to four times a week from one to three hours at a time. Most of our work together revolves around a set of goals that myself and Billy have put together that will enable him to lead to more independence. He wants to have a job. He wants to have his own transportation. He wants to meet a girl. He wants to live a normal life. But, Billy suffers from Bipolar disorder.

bipolar 2Bipolar disorder affects about 5.7 million Americans and there are several forms of the illness. All bipolar disorders have one thing in common. The sufferer cycles through depression and mania. In Billy’s case, he is just labeled “Bipolar.” That’s the thing about mental illness, it never fits perfectly into any one category. Most of the time the sufferer shows symptoms of several different types of mental illness. A person may show signs of bipolar along with symptoms of schizophrenia. It’s up to the psychiatrist to diagnose. But here’s the thing, one may diagnose a patient as bipolar with symptoms of schizophrenia, while a different psychiatrist may diagnose the exact same person as schizophrenic with symptoms of bipolar. At any rate, Billy is being medically treated for bipolar disorder. He’s currently on seven different medications to treat his mental illness along with several other conditions. Many psychiatrists want to limit the different types of meds and will try to consolidate them down. In the case of Billy, a psychiatrist did just that about a year ago with disastrous results. Billy, his mother, and myself sat in the psychiatrist office and literally begged him not to change his meds because of the progress he had been making. He paid no mind and within a week I started seeing a change in Billy’s disposition and energy levels. He began talking about his self negatively and it quickly spread to all facets of his life. He was angry all the time. If he wasn’t asleep he was swearing and pacing around his apartment. I couldn’t make him laugh. He didn’t want to laugh. The easy going and playful guy that I had known just a couple weeks earlier was replaced by a young man who was pissed off at the world and everything in it. It was coming to a head and his mom and I were worried he was going to hurt his self or lash out against someone else. Jail and/or psychiatric hospitalization were in his immediate future. I don’t know about the rest of the United States, but the area we live in, it’s almost impossible to get an appointment with a psychiatrist unless you’re willing to wait six months. Billy didn’t have six months. He maybe had six days. Finally we were able to track down a psychiatrist that had treated him when he was about 17yrs old. We got the meds straightened out and within a week he was coming back around to normal. What I witnessed was just the tip of the iceberg. I talked with him and his mother afterwards and they both agreed that it would’ve gotten much, much worse. His adolescence was completely encompassed with hospitalizations, suicide attempts, and violence. However, Billy is far from that dark place that once resided in his head. Here is his story.

How would you describe yourself? I’m 21 years old and getting ready to turn 22. I live alone in my own apartment. I pay my own bills and stuff. My mom is my payee. I like to hang out with her, my dad (stepfather), and my sister and her family. Also I like seeing my grandma. I’m going to Pennsylvania soon for two weeks to visit with my real dad’s side of the family. I don’t think he’ll be there though. But I like to have fun, watch tv, shoot my pellet gun at cans and stuff. I had a fish for a while but it died. I like eating out and playing video games like Pokemon and Grand Theft Auto. Plus I like watching movies. Mostly cartoons and stuff.

What is your diagnosis? I’m bipolar, ADHD, restless leg syndrome, frontal lobe injury, and I’ve had seizures before. It’s hard for me to sleep because of my restless leg syndrome so I take all my meds before I go to sleep. I still have a real hard time sleeping though. ADHD makes me kind of scatterbrained. But I don’t take any meds for it. I’m on enough already. Seizures happen when I get really, really mad. One side of my body won’t work right. But I haven’t been mad like that in a long time. I have a frontal lobe injury from when I was a baby. My birth dad shook me real hard. That’s how I got that. I was diagnosed as bipolar when I was five.

So how were to you diagnosed so young? Most people aren’t diagnosed until they’re in their 20’s. I guess because of the way I was acting. I was five when I first went to the (psychiatric) hospital. That’s where they diagnosed me.

So what did you do when you were five to get sent to the hospital? I walked into my parent’s room and locked the door behind me. I looked through the room until I found my dad’s revolver. I unlocked the door and walked out into the hallway and stuck it to my head. My mom freaked out real bad. She didn’t know what to do. She called the police and a policeman talked me out of killing myself and got the gun away from me. Luckily.

So you attempted suicide at five. Do you remember why? I just felt like I couldn’t talk to anybody. Nobody could understand me. I was in trouble all the time. I mean all the time. Nobody could figure out why my moods were changing all the time. My mom couldn’t control me. I just wanted to end it all.

What did the doctor’s say when you went to the hospital? Do you remember? I don’t remember much. But I do remember them saying they had never seen anything like me before. I was climbing up onto the counters and jumping off onto the beds. Just doing crazy things. They couldn’t control me. I don’t know how long I was there. They told my mom I was bipolar.

Did you ever try suicide again?
Yea. I can’t remember how old I was the other times. But I tried to hang myself one time but couldn’t figure out the knot. One time I tried to strangle myself to death with an extension cord but I passed out and my arms went limp before I died. One time I tried to electrocute myself by sticking stuff in the wall sockets. It shot me across the room. I’m glad none of it worked though. A lot of that stuff I just try to block out of my mind.

How many times have you been hospitalized? I’ve been in there over 20 times from age five to age 18. I’ve been in hospitals all over the place. All over Virginia and Maryland. They even flew me out to Texas for a couple months because they couldn’t handle me here. I’ve been in a bunch of different schools too. I got kicked out of elementary school because I was acting so bad. One time I waited behind the teacher and when she tried to sit down, I pulled the chair out from under her and she fell down. That’s how I got kicked out of the first one. It was funny, but I wish I could take it back.

Do you think your illness has effected your schooling? Oh yea. Like I said, I got kicked out of school all the time. Fighting and stuff. One time I was at a school for troubled kids and I was about 14 or 15 and I got in a fight. People kept throwing rocks at me and stuff. Then this girl started running her mouth to me. Then she started slapping and hitting my chest. So I punched her and knocked her down. I didn’t even start it. But then she got up and came after me. So I grabbed a chair and fended her off. I smashed her with the chair and then jumped out the window. I ran towards the airport and hid out. I found some construction machinery with the keys still in it. I couldn’t figure out how to start it though.

The police were looking for me, but I crawled back in the window at school and turned myself in. One time I had a girlfriend in high school. She was bipolar like me. I had sex with her. I really liked her a lot. I even went to Wal-Mart and bought a ring for her. I asked her to marry me at school in the hallway. She said she would. But then I went to her house one day and she didn’t know I was coming. Her window was open and I heard her talking on the phone to somebody about all the guys she was having sex with. Some of them were my friends. That really messed me up. I dropped out of school because I couldn’t stand to see her. I only had a couple months left till I graduated. I was living in a home with some other kids at that time and trying to stay out of trouble. But mostly I would go to school for a few months and everything would be okay for a while. Then my meds would stop working because I was growing and changing. Then I would get into a lot of trouble or have a breakdown.

I heard you talk about fighting. Did you fight often? Pretty often. One time at the same home I was staying in during high school, one of my roommates tried to mess with me. I was walking down the hall and he stuck his arm out to try and make me duck to walk by. I just punched him in the face. Once he was on the ground I just kept hitting him. He never did it again. I got into a lot of trouble one time because I beat up my cousin. I was living with my real dad in Baltimore and hanging out with some family. I was probably 15 or 16. I had a little cousin who was maybe 10 or so. He kept getting on my nerves so I cussed him. Then my girl cousin who was about 17 at the time started screaming at me to stop. I punched her and beat her up. Then I took off. When I get mad I just black out. I wake up in either the hospital or jail.

What did you mean when you said that you “took off”? I took off running. My dad never believed that I was bipolar. He thought it was all a hoax. He and my mom split up when I was a kid, and I was living with him at the time. He took me off my meds. All of them. It only took a couple days and I was (manic) bouncing off the walls. After I beat her up, I took off running through Baltimore. I had a girlfriend in a town outside of the city. I ran most of the night. I think I might’ve slept in a building. I remember an elevator. I don’t know what time I woke up. I just remember running again. Then the police found me laying in somebody’s yard. They called my mom and told her that I had collapsed because I had ran so hard for so long. I don’t remember them finding me.

Is that when you came back to Virginia? No. Well, almost. My dad was dating some woman and she had a daughter that was 12 I think. Well, the woman’s mom (little girl’s grandmother) hated me and my dad. She convinced the little girl that I had raped her. She thought that was how she could get rid of us. But I never did it. I’ll swear on a Bible that I didn’t. I would never do something like that. The only people who would believe me was my real dad and my mom back in Virginia. So the police showed up, and I didn’t even know what was going on. They were going to take me to court. But then they told me if I left the state they wouldn’t press charges. So I came back to Virginia to be with my mom.

I’ve heard you mention your dad. Can you talk about him? Yea. He treated me like shit. He thought I was just a bad kid and there wasn’t anything wrong with me. He acted crazy too. My mom and other people in the family think that he is bipolar but that nobody ever diagnosed him. He treated my mom bad too. He was a mechanic and worked on big diesel trucks. I would ride with him sometimes. He was nice when he was working. But any other time he was mean to me. He got into a car wreck when I was a kid and it killed a black lady that lives near my mom. The police couldn’t tell who was to blame for the wreck. He hit her [the woman he killed] head on. He lives in Minnesota now. I haven’t seen him in a long time. Well, since I left Baltimore. That’s six or seven years ago. He got married again and now I have step sisters. But I didn’t even know it. He was mean to my older sister too. He would lock her in her room and wouldn’t let us see each other. Plus he was the one who caused my brain injury. He shook me when I was a baby. But I get along real well with my new dad. I like him a lot.

How do you think your illness has effected your family? I don’t think it bothers them much. But you’d have to ask them I guess. My mom has been married a few times. I never got along with the guys though. One of the guys was an alcoholic. I got tired of him calling me a punk and spitting beer in my face. He had like, four vehicles sitting in the driveway. One time he pissed me off so bad that I went out there and cut every single tire with my knife. That kind of backfired though. They got divorced and my mom had to pay for all of the tires. I was really mean to my sister. I gave her hell all the time. I was probably the worst little brother you could have. But I don’t act like that anymore since my meds are right.

Would you consider yourself a pretty independent guy? So-so. I live in my own place. I buy my own food. I pay my own bills. My mom gets my monthly check and she gives me money out of it. I only get $700 a month. My rent is $375. Plus my internet and cable bill on top of that. I get about $100 in food stamps a month. That will usually last me all month but sometimes I have to pay with cash. You helped me a lot with figuring out money stuff and grocery shopping. But I do some work on the side for the man and woman who live down the road. They’re part of a church. I mow the yard and pickup sticks and do some odd jobs and stuff. They pay me a little bit so that is really helping out now. I’d like to have a job and maybe get one at Goodwill. But I like doing stuff outside and staying busy. My ADHD makes it hard for me to sit still. I do better when I have a lot of structure.

If the doctors hadn’t diagnosed you as bipolar, would you have thought that you were different than other people? No. I would’ve never thought I was any different. I feel like I’m the same as everybody else.

Do you ever feel paranoid like people are out to get you? Yea. But not as bad now. I used to be scared to walk around behind the apartment complex to wash my clothes in the laundry room unless I had somebody with me. You remember that, (I assisted him with working through his fear/paranoia) because I was still doing it when we first started working together. I thought somebody was going to get me. I still keep my pocket knife with me when I walk back there though. I keep a bunch of knives around my bed at night. I can’t have a gun. That’s a good thing though. But I keep my pellet gun there too. I used to sleep with a survival knife under my pillow but you got me to quit doing that. I thought people were breaking into my apartment all the time. Then somebody really did try it! But I’m still not as paranoid as I used to be.

How would you know if your meds quit working? I’ve gotten pretty good at seeing it. I start getting really angry all the time over nothing. It’s for no reason. I don’t like to talk to people. Don’t want to be around anyone. I just stay really pissed off. I’ll get mean even to my family and people I love. I won’t be able to sleep. I start bouncing off the walls. I won’t be able to sit still. Stay awake for days at a time. Or sleep for days at a time.

Where do you see yourself in five years? I don’t see anything. I mean, I don’t see anything bad. I’ll probably be living in the same place. Maybe have a job. Still seeing my family. I don’t think I’ll go back to the hospitals because my meds have me straightened out. Maybe living more independently. Hopefully I can manage all my money on my own by then. Maybe even have a girlfriend or something. But she’s not allowed to live here. That’s the rules my landlord told me.

Do you think this interview will help other people? I hope so. Maybe people are going through what I went through and can relate to me. Or maybe they have a family member that is bipolar. I hope it helps. That’s why I did this.

If you could say anything to a person who is suffering from bipolar disorder, what would it be? Pray. Things might get really, really bad. But just remember that when the doctor’s find the right medicines and doses and stuff, then everything calms down. You can actually live your life. My life was all messed up until I got the right meds and started seeing you. Everything is going real good now.

Bipolar disorder has no cure. Billy will have to manage his symptoms the rest of his life. But through his efforts and the efforts of myself and his support group, he is carving out a life that is worth living. He will probably need mental health support the rest of his days. But, his maturity is constantly growing and his independence is slowly progressing. He is enrolling for GED class and is currently working part-time for some local church members. He is looking for a bicycle and helmet in order to give him some independent transportation to a nearby store (he lives in a rural area and there is no public transportation). His assertive social skills are improving and has made new friends. He has replaced negative self-talk with positive self-talk. His relationship with his family is the best it’s ever been. Things are looking up for Billy. If you or someone you know is suffering from mental illness and need help, please visit your local emergency room and ask for a psychiatric evaluation.


Sidebar: Bipolar I disorder involves periods of severe mood episodes from mania to depression.

Bipolar II disorder is a milder form of mood elevation, involving milder episodes of hypomania that alternate with periods of severe depression.

Cyclothymic Episodes describes periods of hypomania with brief periods of depression that are not as extensive or long-lasting as seen in full depressive episodes.

Mixed Bipolar episodes are periods that simultaneously involve the full symptoms of both a manic and a full depressive episode. It’s marked by grandiose feelings with racing thoughts. At the same time, the person is irritable, angry, moody, and feeling bad.

Rapid-cycling bipolar disorder is characterized by four or more mood episodes that occur within a 12-month period. Episodes must last for some minimum number of days in order to be considered distinct episodes.  Some people also experience changes in polarity from high to low or vice-versa within a single week, or even a single day — the full symptom profile that defines distinct, separate episodes may not be present (for example, the person may not have a decreased need for sleep), making such “ultra-rapid” cycling a more controversial phenomenon. Rapid cycling can occur at any time in the course of illness, although some researchers believe that it may be more common at later points in the lifetime duration of illness. Women appear more likely than men to have rapid cycling. A rapid-cycling pattern increases risk for severe depression and suicide attempts. Antidepressants are thought to trigger and prolong rapid cycling in bipolar disorder. However, that theory is controversial and is still being studied.

Paul Craft
Paul was born, raised in the historic town of Fincastle, Va (just outside of Roanoke). He lives on a registered “Century Farm” that has been in his family since 1906 in a house that was built in the 1790s. His farm has over 300 hundred head of cattle, 6 donkeys, 17 chickens and various other animals along with his dogs, Mike, Buster, and Loki. Paul is married and has three step-children. Paul graduated from Emory and Henry College in 2004 with a degree in Geography and an emphasis in environmental studies. Paul works as a Mental Health Counselor and is currently working towards his Masters Degree in Counseling through Liberty University and will soon be a Christian Counselor.

One thought on “21 and Bipolar: An individual case study.

  1. I really appreciate your client being willing to share his story. Personally, I know very little about this, despite having some distant family members who suffer from it. I found this very informative.

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