Recently, I was asked about planning for the future with bipolar disorder considering the threat of immanent relapse. This individual was in the last year of medical school and wanted to know how to plan the rest of his life, knowing that, at any moment, he might have a bipolar relapse. He was on meds, and they kept him functional, most of the time, but the bipolar medication didn’t prevent two major relapses in the past.
So the questions in this scenario are: How likely is a bipolar relapse? How can I avoid a bipolar relapse? How can I plan a life with such uncertainty?
Some people with bipolar disorder are lucky in that when they get treatment, they find something that works for them within some reasonable period of time (and this might be in a year or two, maybe not altogether reasonable, but on the whole, good). However, not all people sick with bipolar are so lucky. Some people with acute bipolar symptoms don’t find anything that works for them for prolonged periods of time. In fact, for many people sick with bipolar, it seems like they will never find any treatment that will work.
So if you’re in this latter group (and I am) what keeps you going? If you still suffer from acute bipolar symptoms and the treatment isn’t working, how do you keep trying to get better, day after day?
My bipolar brain and mind are interesting places to live. Pleasurable, no, but interesting, yes. At the beginning of the day my mind seems to start out like a blank chalkboard and then my bipolar brain screams at it as soon as I wake. And little by little the chalkboard fills up. Each scream takes up a line. Until eventually there is no room for working thought or working memory or anything all and all I can hear is my brain screaming, “I can’t do this.” It’s a feeling of stress and anxiety and it’s inescapable.
I’m not sure why my brain chooses to yell this particular phrase at me, but I can tell you, it’s impossible to focus through all the yelling.
Raise the Bar on Bipolar Treatment – Hold Your Doctor to Task
Let me be honest. Even when my treatment is at its best, I never get to the place of zero bipolar symptoms. I’m well, I can handle the remaining symptoms with coping skills, I can be happy but there are always lingering symptoms of bipolar disorder.
And this may be an indicator of being difficult to treat because what we know is that the more you can successfully treat all the symptoms of bipolar disorder, the more likely you are to have fewer relapses. In other words, if you continue to experience bipolar symptoms during treatment, you’re more likely to experience future episodes and we really want to avoid that as each future episode tends to make your bipolar harder to treat.
For this reason, it’s critical to aim for zero bipolar symptoms during treatment, whenever possible.
I have told this story before.
Once upon a time I knew a beautiful girl who we’ll call Jane. Jane was curvaceous, feminine, sweet and generous. Jane and I became lovers overnight.
And then life happened and we broke up. My fault, actually. I couldn’t handle having a girlfriend while being in the hospital.
But we remained friends while living our separate lives – very good friends and occasional lovers. It was pleasance punctuated with striking screams.
Then, when I went through electroconvulsive therapy (ECT), I turned to her for help. And help, she did. She stayed with me to help me through the first six treatments of ECT and for this I will be forever grateful. And when she left that day, to return to her life, I said something along the lines of, “Goodbye. I love you. I’ll miss you.” (At least I think I did. The ECT makes it all hazy.)
And she never spoke to me again.
I started thinking about alcoholism the other day because of some stuff going on with a friend and I started to think about how high-functioning people often don’t consider themselves alcoholics because they’re high-functioning. How can I be an alcoholic; I have a job? A family. A wife. Friends. Money. A house. And so on…
And the same is true for people with bipolar disorder. People think to themselves, “I can’t have a mental illness – I have a job.” Or, “I can’t have a mental illness – I’m a good mother.” Or, “I can’t have a mental illness – I have a degree from a top-tier school.”
But as I have told audiences over and over – mental illness happens, and it can happen to anyone.
Bipolar disorder is a mental illness, but many of the problems that come with bipolar disorder are the actions that it provokes. The illness may be in the brain but much of the harm exists in the life around you. You may act out the illness in many ways through anger, hurt, overreaction, panic, hypersexuality, overspending or others. But the question is, are you responsible for your actions when you are in an acute bipolar episode? If you’re severely depressed or manic, are you accountable for your actions?
Would you like the short answer or the long answer? In short, if you have bipolar disorder, no, you shouldn’t be taking an antidepressant – even if you’re depressed – in many, if not most, cases.
The long answer is, naturally, more complicated.
I once had a very nice girl tell me that I was hard to get to know. I was surprised at this. I feel like I’m an open and honest person and if you want to know something about me, you can just ask and I’ll generally answer.
I didn’t prod her for more details when she said it, although I probably should have. What I think she might have meant was that I was hard to get to know emotionally. I think what she was saying is that I wasn’t showing my emotions around her and that was the hard part to get to know. This girl, in particular, wore her emotions on her sleeve, so I can understand the disconnect. She was right. My emotions are hidden. But that’s because not even I want to know them and I can tell you right now, no one else really wants to know them either.
Sometimes I’m Just Mad
As I have stated, over and over, that to experience bipolar disorder is to experience such inflated emotions that they swallow you whole. Bipolar emotions are bigger than you and the particularly nasty ones are bigger than any therapy or coping skill could ever be.
However, not every emotion is a bipolar emotion. Just because I feel a strong emotion like anger, sadness or elation, that doesn’t mean it’s a bipolar overreaction I’m feeling. It’s not necessarily depression, mania or hypomania. Sometimes, people with bipolar disorder feel just like everyone else. Sometimes we’re just reasonably mad.
So, as it turns out I’m a bit of a mental illness stigma eraser – or at least so sayeth the amazing folks at Didi Hirsch. I’m extremely proud, honoured and humbled to announce that Didi Hirsch will be honouring me at this year’s Erasing the Stigma Leadership Awards in Los Angeles.