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Bipolar News

June 24, 2005

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Bobby Brown takes his reality TV turn
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Epilepsy, Bipolar Drugs Carry Birth Defect Risks
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Expert calls for NHS to tackle soaring levels of workforce stress, UK
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Treatment Rate for Mental Illnesses Rising in USA, Study Shows
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2 mental disorders may be connected.

The Fresno Bee (Fresno, CA); 6/21/2005; Hoagland, Doug

Two mental disorders ruled Brittany Benov's life.

She was diagnosed with bipolar disorder and borderline personality disorder.

It's not unusual for patients to have both, and there probably is a relationship between the two, says Dr. James Potash. Potash, a psychiatrist, is co-director of the Mood Disorders Program at Johns Hopkins School of Medicine in Baltimore.

"People whose bipolar disorder begins at an early age may not have their personality development occur in the usual way," Potash says. "The instability in their moods may lead to an unstable sense of self, which is characteristic of borderline personality disorder."

Each disorder has its own characteristics:

Bipolar disorder

Also called manic-depressive illness.

More than 2.3 million American adults have bipolar disorder in a given year.

Caused by abnormalities in brain chemistry and/or brain circuits.

Typically occurs in late adolescence or early adulthood.

Has two main forms: bipolar 1 and bipolar 2.

Mania and depression occur in bipolar 1.

Mania symptoms include euphoria or irritability. Other symptoms: exaggerated self-esteem, less need for sleep, overtalkativeness, racing thoughts, distractibility, physical agitation and excessively risky behavior with money or sex.

Depression symptoms include persistent sadness. Other symptoms: loss of interest in pleasurable activities, major changes in weight or appetite, sleep disruptions or oversleeping, difficulty concentrating and recurring thoughts of death or suicide.

Bipolar 2 is less severe.

Bipolar 2 symptoms include hypomania, characterized by increased energy, euphoria, irritability. Depression can be moderate or severe.

Bipolar 1 and 2 are 75% genetically determined, says Potash: "You inherit the genes that predispose you to it."

Stressful situations might trigger bipolar if a person has a genetic predisposition, Potash says. What kind of stress? "It depends on the person. Nobody knows for sure. In some people, stress like a divorce or death of a loved one may play a role."

Treatment includes medications and psychotherapy.

Borderline personality disorder

Affects more than 4 million American adults; 75%-90% are young women.

Falls between neurosis and psychosis. Patients are on the border of being able to function.

Symptoms vary. There are episodes of anger, depression and anxiety.

Other symptoms: unstable emotions, mood swings, extreme fear of abandonment and impulsiveness, including binge eating, excessive spending and risky sexual behavior.

Cause is unknown. Experts believe both genetic and environmental factors play a role in predisposing patients to the borderline disorder.

Research says many, but not all, patients report abuse, neglect or separation in childhood.

Large numbers of patients (40%-71%) report having been sexually abused, usually by a noncaregiver.

Experts disagree on when a diagnosis is possible. Some say not before age 18.

"Clinically that is absurd. We see severe personality disorders already in childhood," says Dr. Otto F. Kernberg. Kernberg, a psychiatrist, is clinical director of the Borderline Personality Disorder Resource Center at New York-Presbyterian Hospital.

Most commonly occurs in late adolescence or early adulthood when young people leave family structures and familiar friendships, according to Kernberg.

Treatment includes psychotherapy plus a special therapy, dialectical behavior therapy (DBT). Anti-depressants, mood stabilizers and anti-psychotic drugs may be prescribed.

Sources: National Institute of Mental Health; Mood Disorders Program, Johns Hopkins School of Medicine; and Borderline Personality Disorder Resource Center at New York-Presbyterian Hospital.

Resources

Mood Disorders Program, Johns Hopkins School of Medicine: (410) 955-5212, www.hopkinsmedicine.org.

Borderline Personality Disorder Resource Center: (888) 694-2273, www.bpdresourcecenter.org.

National Institute of Mental Health: (866) 615-6464, www.nimh.nih.gov.

National Alliance for the Mentally Ill: (800) 950-6264, www.nami.org.

Fresno County Department of Behavioral Health, adult referrals: (559) 453-4099, www.co.fresno.ca.us.

Fresno County Children and Family Services, child referrals: (559) 453-8918, www.fresnohumanservices.org/childrenandfamilyservices.

Kings View Counseling Services for Kings County: (559) 582-4481, www.kingsview.org.

Madera County Behavioral Health Services: (559) 673-3508, (888) 275-9779, www.madera-county.com.

Tulare County Health and Human Services Agency Information and Referral Line: (800) 834-7121, www.tularehhsa.org.

The reporter can be reached at dhoagland@fresnobee.com or (559) 441-6354.

COPYRIGHT 2005 The Fresno Bee. All rights reserved. Reproduced with the permission of the Dialog Corporation by Gale Group.

Deep pain marked young woman's final days.

The Fresno Bee (Fresno, CA); 6/21/2005; Hoagland, Doug

Brittany Benov was mentally ill.

It was why she went into the bathroom at a New Year's Eve party last December and cut her throat with a shard of glass from a mirror.

Her genetic tendencies had mixed in a complex, inexplicable way with the stresses of her life, her temperament, her personality and her upbringing. Change one factor, and the outcome might have been different. Or perhaps not.

Doctors said Benov had bipolar disorder, a mental illness that affects more than 2 million American adults in a given year and is caused by abnormalities in brain chemistry. People often inherit a predisposition for the disorder and it strikes many people in their late teen years or early 20s. It is commonly known for two mood extremes: mania and depression.

Benov's bipolar, however, was a variation with less mania, says her New York psychologist.

Doctors also diagnosed Benov with borderline personality disorder, which strikes more than 4 million American adults, most of them young women. The borderline disorder is known for unstable emotions, mood swings and fear of abandonment. The cause is unknown, though researchers believe genetics and life experiences both play a role.

Again, Benov's New York psychologist qualified the diagnosis, saying she suffered from a combination of personality disorders.

There was no cure. Stability was the goal after Benov got her diagnoses in the summer of 2000, nearly two years after moving to New York from Fresno, where she had been a minor celebrity as a model and performer. Benov was hospitalized at least six times, once with a roommate who smeared feces on the walls.

Kathy Benov, Brittany's mother, flew to New York during many of the hospitalizations and brought her daughter back to Fresno several times. She looked for local treatment and found doctors but no private hospital that would take Brittany. One hospital turned her away because she wasn't "in crisis."

Kathy Benov grew frustrated, then exhausted and finally numb.

She wondered whether Brittany had been correctly diagnosed and was getting the right pills. The stress was intense. Today, Kathy Benov talks of her daughter's life because she says she wants to help others facing mental illness. In the beginning, when she had a label for Brittany's behavior, but no real answers, Kathy Benov sometimes felt very alone.

Susan Brown, a New York clinical psychologist, helped Kathy Benov understand Brittany's illness. Says Benov: "She helped me by saying, 'If your daughter had leukemia, you would be by her side, as would all her friends. You have to see it as a life-threatening disease.' "

It was a disease that kept Brittany Benov living in deep despair, says Brown: "My God, what she was contending with. The amount of pain she was dealing with was staggering."

Doctors prescribed medications, but she didn't always take them. She either ran out of money or didn't get the prescriptions filled or used the medications too quickly during bouts of anxiety. The pills also left Benov tired and made her gain weight, neither of which she liked.

The goal was to even out her moods, which could cycle rapidly. She described their progression in an essay: "The order of today: normal, surreal, damaging, disgust, searching, depression, unsettled."

She wrote in the same essay: "There are weeks when I only go about 10 feet outside my front door. My apartment is the comfort zone where I hide or feel so cooped up that the air I breathe seems filled with the words 'Let me out!' ... I work for a while at a job until I feel like my head will explode and the only thing left to do is allow the complete break that has been building in my brain. The break is swift. I am beyond tired. I have failed again."

Benov had failed to become the Broadway star or cabaret jazz singer she dreamed of being. She failed at friendships. She failed to control her anxiety.

And yet, as childhood friend Kalia Abiade said of Benov's mental illness: "It wasn't who she was. It was just something she dealt with."

Maybe that was true, or maybe it's what the people closest to Benov wanted to believe as they watched her self-destructive behavior. The Brittany Benov they knew had been a girl full of contradictions. Talented. Sensitive. Smart. Petty. Selfish. Demanding. The girl everyone envied. The girl who felt pressure that few understood.

Then her mind betrayed her, and she was subject to cycles and episodes she felt unable to control. She felt particularly afraid when she was unsure of what was real in her world. "When she was anxious she would grab practically anything to make herself feel better," Brown says.

It could be alcohol, drugs or sometimes even staying in bed for days watching the DVDs of her television favorites, "Alias" and "Buffy the Vampire Slayer." She called the DVDs "my true sanity."

Benov's thinking could be delusional and she sometimes wanted to bleed out of her veins what was wrong in her mind. She said she had been cutting herself since she was a teenager.

On New Year's Eve 2004, Benov was drinking and probably cut herself because she was feeling overwhelmed by being alone at the party, says Brown.

Benov's cuts to her throat were only superficial. Then she threw up and talked of how desperate she was.

"She kept saying she felt worthless and didn't want to live," says friend Lisa Conlon. "She was so depressed and unhappy because she didn't have a guy. She was talking how it wouldn't make a difference if something happened to her."

Her friends cleaned her up, put her in a cab and she went home.

"It seemed like she was going to be OK," Conlon says.

She wasn't. Benov sat in her one-room apartment in a city where happy people drank and danced and made love beyond her walls.

And she was alone.

Benov opened the bottles of her psychiatric medications and took the pills. Too many of the pills. She then punched a number into her cell phone.

Benov was calling Brown, who was visiting her husband's parents in North Carolina.

The psychologist picked up the call and Benov began to talk, though not always coherently.

"Brittany was fading out on me and as I talked to her she was getting weirder and weirder," Brown says. "I told her to keep the door unlocked for the EMTs."

Brown then hung up and called New York to get emergency crews on their way to Benov's Manhattan apartment. An ambulance took Benov to the hospital, and on the way she.phpirated some of her vomit and the EMTs had to put a breathing tube down her throat.

Mental illnesses follow no logical progression, however, and dark episodes can be followed by periods that seem almost normal. Benov experienced that after she recovered from her New Year's overdose.

Three days later, she talked with Brown. They discussed what had happened and what Benov wanted to do now. She was sober and relatively upbeat.

Benov wanted to lose some weight. She wanted to go back to school. She promised to behave at her brother Matthew's June 4 wedding. And she vowed not to repeat the New Year's drama with the broken glass and the pills. She said she wasn't trying to kill herself and had learned a valuable lesson about the consequences of her actions.

Yet, less than three months later, she was dead.

Benov once wrote in an essay that she had given up on a normal existence: "In all honesty, I'd say that I've lived my life. The thought of enduring another 20 years alive seems like the most horrible thing I can imagine. It's not the desperateness of suicide but rather a calm realization that I do not want to be in this world much longer."

Did she kill herself? It's a question New York authorities would have to answer.

As the first days of 2005 became the first weeks of the new year, Benov got good news: her mental illness qualified her for disability benefits. The federal government also said she was entitled to $11,000 in back benefits, according to her mother.

Brittany Benov went on a shopping spree despite her family's advice to put some of the money aside for the future. She was in no mood to listen about her windfall, but was showing some openness to learning to manage her illness.

That's what would make her death so ironic. Maybe she was finally getting better, or at least turning in that direction. Her psychologist believes Benov was taking her medications, and in early February she began attending a day treatment program for people with personality disorders.

At first, she didn't like the new program, but she came to believe it was doing her some good.

She could still be impulsive, though, and she hatched the idea of taking her mother to Italy for her 50th birthday. Kathy Benov initially was against it, but she finally gave in: "I could never tell her 'no,' " she says.

Brittany Benov used some of her disability money to pay for part of the weeklong trip. Her mother, a human resources administrator for a Fresno engineering company, covered the rest.

Kathy Benov says today she cherishes the memory of that journey in early February. The trip was leisurely, Rome and Venice were beautiful and she was with Brittany for the last time.

After returning from Italy, Brittany Benov resumed therapy with Brown and saw her for the last time Feb. 23. After 18 months of therapy, Brown had developed warm feelings for Benov.

"She was funny. She was brave. She was insightful. She worked hard. She was smart," says Brown.

But her actions also would have tried the patience of a saint, Brown says: "She had an illness that made her erratic, and erratic she was."

Brown shudders at the potency of Benov's illness.

"I'd rather have cancer, myself. Cancer is a disease of the body, but with bipolar and a personality disorder, you aren't a stable entity unto yourself. You can't rely on any part of yourself. You have no stability, nothing to count on, nothing to refer to. From day to day, moment to moment, you don't know what to hang onto."

When she was in that state of mind, Benov often turned to her mother for help. Theirs was a conflicted, turbulent relationship but at the end, Brittany Benov had concluded that among all the people in her life, she could count on her mother.

"My mom is a real support system for me and I feel like life is better when we are getting along together," Benov wrote on a March 1 assignment for her new therapy program.

Eight days later, Kathy Benov had a hysterectomy in Fresno, and Brittany was afraid that her mother would die during the operation. She didn't.

On March 10, Brittany called her brother Matthew's fianc?e, Bridget Crothers, about their June wedding. Brittany was going to be one of the bridesmaids even though she was unhappy with her appearance. She also was thinking of singing at the wedding, which Crothers considered a major step forward. Crothers had not heard her sing for two years.

"She sounded happy, really good," Crothers said. "Brittany was very caring and sincere. Even with the things going on with her life, she would call and say, 'Hey, what are you up to? I was thinking of you today.' She still cared about other people's lives."

Her telephone calls continued the next day. She was in touch with her friend Kalia Abiade, whose grandmother was near death. Brittany was concerned.

She called her brother Matthew that day. He is a lawyer and she wanted some legal advice, but he had a meeting so they didn't finish their conversation.

Brittany also called her mother, who was still in the hospital and not feeling well enough for a long talk. "I'll call you tomorrow," Kathy Benov said.

That night, Brittany Benov talked with her New York friend Lisa Conlon about getting together. Conlon couldn't because of work, but she thanked Benov for helping her get through a recent breakup with a boyfriend.

"I'll always be there for you," Benov told her. The two women said they loved each other.

Today, Conlon says softly: "I'm thankful that I got to say that to her."

Benov went out that night with a new friend from the therapy program for personality disorders. The details of that night are unclear, as is Benov's frame of mind. However, in her therapy program, she had written of the apparent tension between her "wise mind" and her "emotion mind." She made up dialogue between her two minds that might have occurred in a bar or nightclub.

Emotion mind: "Can I buy you a drink, pretty lady?"

Wise mind: "Sure."

Emotion: "How about 10?"

Wise: "No thanks, I have class tomorrow."

Emotion: "Then how about some randy sex?"

Wise: "I'm in a relationship."

Emotion: "With who?"

Wise: "Myself."

This much is known: Benov met a man named John Quinlan that night and went back to his brownstone apartment.

Quinlan walked his dog the next morning, says Mark Benov, Brittany's father, who spoke to authorities in New York. Quinlan returned to find Brittany in bed and in distress. Quinlan called 911 and attempted cardiopulmonary resuscitation, but an emergency medical crew arrived and pronounced Benov dead at 10:46 a.m.

She died from "acute intoxication due to the combined effects of opiates, cocaine, Paroxetine, Quetiapine, Tramadol and Bupropion," according to the New York City Medical Examiner's Office. Paroxetine and Bupropion are anti-depressants; Quetiapine is an anti-psychotic and Tramadol is a painkiller.

The death was an accidental drug overdose, says spokeswoman Ellen Borakove: "Anyone who dies of a drug overdose is by policy presumed to have died an accidental death unless we have evidence the person was trying to commit suicide."

Brown also believes it was an accident.

Quinlan doesn't live in the brownstone anymore; he was told to move after Benov died there. He could not be reached to talk about her.

Brittany once wrote of what it would feel like to drown, and her vision of death was haunting. "The faces are the beginning ... The faces of those I love casting me into a place where they can't or won't follow. As I sink, I read some pain on their faces, but it's mostly the pity and the blessed sigh of relief."

Kathy Benov was still in the hospital when her mother came with the news about Brittany.

When she thought about it later, Kathy Benov was glad that her daughter had gone to the man's apartment even if he was a stranger. "It's a blessing because she wasn't alone," Benov says. "She wasn't sad. She wasn't by herself."

Two days after Benov's death, a notecard arrived at Kathy Benov's home. "Mom. Just wanted to wish you a speedy recovery. I wish I could be there to take care of you. I miss you very much. I love you."

The note was signed: "Always, Britt."

Kathy Benov says Brittany did not blame her for the mental illness. "I don't know what's wrong with me, but you did not cause this," she wrote one time after getting out of a psychiatric ward. But she wasn't always so magnanimous, sometimes telling her mother that she hated her.

Kathy Benov says she will forever struggle with the question: "What could I have done different to have saved my daughter's life?"

She clings to one certainty: "Brittany did not choose this. Who would? And not only didn't she choose it, she didn't cause it to happen."

Brown says it would be too simplistic to blame anyone for what happened to Benov.

"We are all shaped by our families," Brown says. "But I don't think Brittany's illness can be blamed on the family in any direct way."

A week after Benov's death, her family and friends gathered at her mother's house. A DVD showed Benov over the years. It began with her wearing frilly white dresses in little girl beauty pageants and ended with a young woman in black Lycra performing at her senior recital in New York. In another room, a CD played. On it, Brittany was singing "Stormy Weather," which was appropriate because it rained on the day people came to Kathy Benov's house to say goodbye.

In the state of mind she was in, Kathy Benov saw that as no coincidence. "I said, 'Oh, Brittany, you are always such a drama queen. This is just like you.' "

The following Wednesday, a small box wrapped in brown shipping paper arrived from New York in the mail. Bridget Crothers, the fianc?e of Kathy Benov's son Matthew, answered the door and took the package from the postman.

Kathy Benov, who feared what it was, retreated to her bedroom.

Crothers carried the wrapped box to the doorway of the bedroom, paused there and spoke.

"Brittany's here."

Crothers placed the box filled with cremated remains on the bed and the two women held hands and sobbed.

Kathy Benov has never unwrapped the box. Instead she enfolded it in a pair of blue fleece pajamas decorated with bears that she gave to her daughter last Christmas. During the day, Kathy Benov puts the pajamas and wrapped box behind the pillows on her bed.

At night, she sleeps next to them.

"I could not keep her safe when she was alive," Kathy Benov says, her voice breaking, "but I can keep her safe and warm with me now."

The reporter can be reached at dhoagland@fresnobee.com or (559) 441-6354.

Brittany Benov -- best known to Valley residents as the sunny little girl in the Fashion Furniture TV commercials -- died this March in the New York City apartment of a man she had just met. She was 24. The Fresno native wanted stardom. Instead, she slipped into cycles of self-destruction with drugs, alcohol and sex. Her life was reeling out of control last New Year's Eve when she asked a man at a party for a midnight kiss and he refused. Benov found a shard of glass and cut her throat.

Kathy Benov reflects on the life of her daughter, Brittany, while looking at the box containing Brittany's ashes. Today, she talks about her daughter's life because she says she wants to help others facing mental illness. When she had a label for Brittany's behavior, but no real answers, Kathy Benov sometimes felt very alone.

At left, Brittany at 16, in a photo for the KMPH Fox 26 Kids Crew show; center is a college photo; photo at right is Brittany in February, shortly before she died.

Two days after Brittany Benov's death, this notecard arrived at Kathy Benov's home.

Kathy Benov and her daughter, Brittany, visited the Pantheon in Rome in February. The trip was to celebrate Kathy's birthday, and it was the last time she saw her daughter alive. Kathy Benov says today she cherishes the memory of that journey.

"We are all shaped by our families. But I don't think Brittany's illness can be blamed on the family in any direct way."

- Susan Brown, a New York clinical psychologist who treated Brittany benov

COPYRIGHT 2005 The Fresno Bee. All rights reserved. Reproduced with the permission of the Dialog Corporation by Gale Group.

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