- The Washington Times - Saturday, November 29, 2003

The sunshine streaming through Sandra Dobry’s window and the sound of schoolchildren playing outside make the 59-year-old woman smile and think she must be one of the most fortunate, happiest people in the world, she says.

But occasionally, Ms. Dobry says, her thoughts and emotions are so dark that she doesn’t even notice that same brilliant sunshine and happy sound of schoolchildren.

“It’s bright out there, but in here,” she says, pointing to her head, “it’s completely dark. I feel like nobody loves me, that I’m worthless,” says Ms. Dobry of Linthicum, Md. “I start thinking, ‘How can I kill myself without creating a mess.’”

Ms. Dobry has bipolar disorder, a psychiatric illness characterized by drastic mood swings. The disease, also known as manic depression, of which there are two types, affects between 4 and 10 percent of Americans, says Dr. Jennifer Payne, Ms. Dobry’s psychiatrist and an assistant professor in the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins School of Medicine.

Bipolar disorder can be fatal, particularly if it goes untreated, Dr. Payne says.

Up to an estimated 15 percent of bipolar patients commit suicide, the psychiatrist says. (Deaths also follow the reckless behavior that some bipolar patients engage in, be it drug use, fast driving or inappropriate sexual behavior that can cause them to acquire HIV, she says.)

While Ms. Dobry has suffered from the highs and lows of bipolar disorder her entire life, she is not the illnesses’ only victim. Her three daughters, who are all in their 30s, have paid a price, too.

While their mother kept an immaculate home and was very loving toward them most of the time, they say they clearly remember their mother’s suicide threats and other erratic behavior, which scared them.

“I remember how she was dressed in this black nightgown and called us girls in one by one to her bedroom to bid farewell,” says Lisa Bullock, 30. “I was terrified.”

Mrs. Bullock, who is now a stay-at-home mom in Westminster, also remembers other bizarre episodes.

“There was the time we took a crowbar to our television and smashed it,” she says. “[Our mother] had decided television was evil. And I remember thinking, ‘Why don’t we just sell it?’”

Mrs. Bullock and her sisters, Deborah Waters, 37, of Hanover, Pa., and Kelly Dobry, 35, also of Westminster, say that they felt powerless when their mother would act strange but that they didn’t know what was wrong with her. No one did.

“Part of me thought that it was me, my fault somehow,” Mrs. Waters says. “So I tried that much harder to please.”

However, nothing the girls (or girls’ father, from whom Ms. Dobry has been divorced for more than 15 years) did — no matter how neatly they folded their clothes or cleaned their rooms — would make their mother better.

“Nobody was talking about psychiatric illness then,” their mother says, “and I had no idea. Now I am convinced I’ve been bipolar my whole life. I felt different, like an outsider, even as a child.”

Ms. Dobry was diagnosed with bipolar disorder five years ago, at age 54. She was being treated for a knee and chest injury, the result of an automobile accident, when her primary care physician referred her to Dr. Payne.

The primary care doctor had been treating Ms. Dobry for depression, but without success, says Dr. Payne, who ultimately diagnosed her with bipolar disorder.

“It was such a relief to me that there was a name for what my mother had and that it didn’t have anything to do with what I had or hadn’t done,” Mrs. Waters says.

Dr. Payne says Ms. Dobry’s type of psychiatric condition, bipolar disorder II, often goes undiagnosed for years because it can be less severe, and therefore less obvious, than the other common type of manic depression, bipolar disorder I.

Patients with bipolar disorder I have such violent ups and downs that they often require hospitalization, providing doctors with a chance to diagnose the psychiatric illness. The highs of a bipolar disorder II patient usually don’t result in drastic, destructive behavior, Dr. Payne says. Instead, these patients may spend hours, day and night, frantically cleaning the house or rearranging furniture, which Ms. Dobry does.

About 1 percent of the population is considered to have bipolar disorder I, while between 3 percent and 9 percent of the population is considered to have bipolar disorder II, Dr. Payne says.

Ms. Dobry’s type is characterized by depression and “hypomania.” The “hypomania” is less severe than the “mania” that patients with bipolar disorder I experience.

Another characteristic of Ms. Dobry’s disorder is that she cycles rapidly, meaning she goes between hypomania and depression very frequently, as often as two or three times a week. Some patients only cycle a couple of times a year, Dr. Payne says.

Ms. Dobry, like many bipolar patients, is treated with several mood-stabilizing medications, including anti-depressant Wellbutrin, to control the illness.

The daughters have noticed an improvement in Ms. Dobry since she started seeing Dr. Payne. They say that her depressions don’t seem to be quite as deep and that she doesn’t call them in hyper or desperate moods as much as before.

Their mother agrees.

“I think the medication has helped a lot,” she says. “This is a disease. You can’t just will it away.”

She also visits Dr. Payne on a regular basis, but not frequently enough, the psychiatrist says. They sometimes meet and talk as little as once a month.

“I would like to see Ms. Dobry once a week, but for financial reasons that’s not possible,” Dr. Payne says. Medicare covers half the cost when Ms. Dobry, who is on disability, visits Dr. Payne.

Aside from counseling and medication, Ms. Dobry finds comfort and peace in the Messianic Jewish faith. Her three-bedroom house is filled with Bibles (she says she has 50 of them) and her stereo plays religious CDs — such as “Pray for the Peace of Jerusalem,” by Paul Wilbur, and “I Came to Worship you,” by Terry MacAlmon.

“I play this music 24 hours a day because the devil doesn’t want to mess with any place filled with God,” she says. “I know that if it weren’t for the Lord, I’d be dead.”

Dr. Payne, who has been treating Ms. Dobry for five years, says bipolar disorder is so complicated that doctors continue to tweak medications and therapy to find the best care for their patients.

“The next thing I am going to do is meet with Ms. Dobry’s daughters,” Dr. Payne says. “I would like to get their observations over the last couple of years and compare them to what Ms. Dobry has told me.”

Ms. Dobry’s daughters also say they can play an important role in their mother’s treatment.

“I think Dr. Payne has done only half her job until she’s talked to us,” the younger Ms. Dobry says. “Until she talks to us, she has no idea who she’s dealing with.”

The daughters are scheduled to meet with Dr. Payne tomorrow. It will be their first meeting.

Family’s coping mechanism

Growing up, the daughters say they never doubted their mother’s love for them. She was high-energy and could be a lot of fun. However, for comfort and consistency, they knew they couldn’t look to their mother, Mrs. Bullock says.

“The sisters really stuck together and supported each other. We still do,” she says. “When I was a teenager, Kelly and Debbie were the ones who drove me places, did my hair, things like that. It wasn’t my mother.”

Mrs. Waters says she and the sisters “held on to each other like life rafts.” She says she didn’t have very many friends because she was afraid other girls wouldn’t understand what she was going through with her mother’s illness.

The younger Ms. Dobry agrees. “Without my sisters, I think that I would be completely lost. I think we’ve been each other’s sanity,” she says.

For role models, Mrs. Bullock looked to friends of the family.

“I was close to several adult couples growing up who were more functional,” Mrs. Bullock says. “I could look at them and say, ‘That’s the kind of family I want.’”

The sisters are still as close as they were growing up, but their relationship to their mother has gone through some changes. They still love her very much, they say, and they respect all the good things she does for them, their children and other people — Ms. Dobry helps the homeless on a regular basis.

However, for their own well-being, they had to change the rules in their relationship with their mother.

A few years ago, Mrs. Bullock cut communication with her mother entirely for about four months to try to figure out what she wanted from the relationship and how she could get it. She decided to set boundaries.

“I decided I was not going to get on her roller coaster,” Mrs. Bullock says.

The younger Ms. Dobry has also started setting boundaries of when and what she can talk about with her mother.

“I can’t tolerate the cyclical events and erratic behavior, and as a result I just stay away,” she says.

Mrs. Waters, whose five children see a lot of their grandmother, says she is probably the most “enabling daughter.” She still feels very responsible for her mother’s well-being and is unable to set limits the way her sisters have. She talks to her mother at least once a week, but sometimes as often as every day.

“I know that I have been a good daughter, but I still have some healing to do,” says Mrs. Waters, who is currently in therapy.

Their mother hopes the daughters — particularly the younger ones — will be less harsh toward her once they have talked to Dr. Payne.

“Sometimes, Lisa is tough on me. I think once she understands the disease better, she’ll soften up,” Ms. Dobry says. “Life has been an incredible struggle for me. I hope one day, they will understand.”

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