Mental Illness

Misconceptions I Used to Have About Bipolar Disorder

There is a an episode of Crazy Ex-Girlfriend where the main character, Rebecca Bunch, finally receives a medical diagnosis for her mental health issues. From the beginning of the show, she assumed her issues were anxiety, depression, and OCD, but after a psychotic episode, a doctor tells her he has an official diagnosis for her. At first, Rebecca is relieved about this and is even looking forward to finally knowing what her issues are. Since this is a ridiculous show involving choreographed musical numbers, Rebecca sings a power anthem about how finally finding the right diagnosis will change everything. A few days later, she finds out she is being diagnosed with Borderline Personality Disorder. After a quick Google search of the characteristics, she demands that her doctor give her a new diagnosis. In that moment, Rebecca would rather live without proper treatment in order to avoid an undesirable label.

As I’ve started to write about my experience with bipolar disorder, I have heard from so many people who thanked me for sharing, but who also expressed that they struggled with their own diagnoses –not so much with managing the symptoms, but with accepting the reality that they have bipolar disorder. These are people who, like me, have struggled with their own misunderstandings of the condition and above all, with other people’s perceptions of it.

When I was first diagnosed, I was very uncomfortable with the label “bipolar.” It sounded extreme, and it both frightened and embarrassed me. But then I spent time learning about what it actually is and how my experience fits inside the spectrum of the disorder, and I started to feel immense relief. I’m sure this sounds like an oxymoron to some people, but I had a moment where a light went on and I thought, “I’m not crazy, I’m just bipolar.”

I thought it might be helpful for me to share some of the things I used to believe that made it hard for me to accept the reality of my diagnosis.

Misconcpetion #1: People with Bipolar Disorder are Erratic and Dangerous

First off, let me just begin by saying that any statement beginning with “People with bipolar disorder are x, y, or z” is probably wrong. That’s sort of like saying, “All pregnant women will have morning sickness.” Yes, there are things about pregnancy that make morning sickness more likely, but there are women who never experience it, women who are sick once, women who are sick for a few weeks, and women who are sick constantly their entire pregnancy. Whatever scale the symptoms are on does not change the fact that they are all pregnant.

In the media, we often see the extremes of BD–people or characters who are at the highest heights of mania or the lowest depths of depression. These extremes do exist, and they are heartbreaking, but they are not the definitive experience of BD. And it’s not common for people to reach these extreme states if they are receiving proper medical care.

It’s also worth noting that an official diagnosis of Bipolar Disorder is characterized by having consistent depressive periods and at least one manic (Type 1) or hypomanic* (Type 2) episode in their lifetime. ONE. Of course, lots of people have more than one. But I’m just saying, to assume that someone with BD is constantly having or on the verge of having erratic and irrational episodes is just not true.

Misconception #2: Being Bipolar Means Having Rapid Mood Swings

“My teacher is like totally chill one day and then yelling at us the next. She is so bipolar,” I overheard a 7th grader saying to her friend. People toss around the term like it’s the punchline of a joke. Sometimes I like to joke about it too, because sometimes it’s healthier not to take ourselves too seriously, but also, this perpetuates the idea that bipolar really means “Someone with wild mood swings.”

If having mood swings were the metric of what makes someone bipolar, about half of the world’s population would be bipolar approximately once a month. Have you ever started the day in a bad mood and then had something totally turn your day around? Or been in a great mood and had something bring you down? That’s a pretty normal experience. Emotions fluctuate and some people are more sensitive than others.

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Bipolar Disorder does not mean having constant mood swings all day every day. It means having longer term cycles of depression, stasis, and (at least once) mania or hypomania. In many cases, those cycles come only once or twice a year.

There IS something known as rapid-cycling BD, but rapid cycling refers to having four or more cycles in a year. That is still not the same thing as having a flip of the switch mood swing or a Dr. Jekyll and Mr. Hyde personality.

In other words, sometimes, a girl is just hangry, OK? Give her some cheese. (If she is me).

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Misconception #3: Bipolar People Can’t Live Normal Lives. They End Up Homeless or Dying Young and Tragically

There are two parts to this one – first, the idea that people with BD can’t live normal lives. In fact, most people with BD experience (sometimes long) periods of normality in between periods of depression and mania/hypomania.

People who experience BD with severe depression (especially if untreated) may have difficulty holding down a job because they can’t keep a regular schedule. People who experience BD with extreme mania that causes them to have delusions or make other reckless decisions (especially if untreated) may put themselves in risky situations. And yes, people who leave their BD untreated or who choose not to seek help will probably not live a healthy life.

But, BD is not a hopeless diagnosis. There so many treatment options, both with medication and without. Some incredibly successful people are/were bipolar (Carrie Fisher, Catherine Zeta-Jones, and, for better or worse, Ernest Hemingway to name a few). In fact, I would argue that people with BD are some of the most passionate, creative, and empathetic people on the planet. Those same emotions that can overwhelm and cripple us also give us a rich and complex emotional and creative life.

When I was first diagnosed, my biggest fear was that someone would find out and think I was unfit to do my job, which involved a huge amount of responsibility of a group of teenagers. I did not want anyone to hear the word “bipolar” and make assumptions about me or my work based on that one word rather than on my character and my proven track record. I think this is a common concern for people with bipolar disorder, and that’s why I think it’s so important to educate people about what it really is.

Misconception #4: If Someone I Knew Was Bipolar, I Would Know

Nearly everyone I know who is aware of my condition has the initial reaction, “But you seem so (normal/competent/together/calm/happy/successful, etc.)!”

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I just like smiling. Smiling’s my favorite. This face right here – this is me at the tail end of one of the most severe depressive episodes of my life.

Newsflash. The way people look on the outside and the way they feel on the inside do not always match up.

I have spent months at a time somehow getting up, putting on my makeup, pulling myself together, and doing my job with a smile on my face. And the minute I got home, I would put on my sweatpants and spend the rest of the day on my couch or in my bed barely speaking because it was SO BONE-NUMBINGLY EXHAUSTING to make it through the day. I never wanted to wear a mask, I just had responsibilities and I had to keep functioning.

Of course, I understand that there are people with BD who genuinely cannot do that. I get it. There have been at least two points in the last few years where I thought, “I’m about to break.” I honestly don’t know how I got out of bed, and to anyone else who has felt that way or worse, I believe you are doing the very best you can.  But a lot of us are very high-functioning and great at over-compensating for how we feel inside.

Not only are the symptoms we experience internal and therefore not noticeable unless you are really close to us every day, but it’s also something people are afraid to talk about. At least, I know I was. Sometimes the people who suffer the most are the ones who nobody notices are suffering.

Some Advice

I know this has been long, but I would like to leave you with a few last thoughts. If someone you know and love confides in you that they have bipolar disorder:

  1. Ask them, “What is that like for you?” Remember that it can be different for everyone.
  2. If you are concerned about them taking care of themselves, ask them what they are doing to help themselves manage it.
  3. Educate yourself.
  4. Other than providing them with any support they may ask for, treat them the same way you did before you knew.

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*Hypomania is a less extreme form of mania that usually lasts for a few days rather than weeks and is characterized by being happy/euphoric, full of energy, being very talkative, racing thoughts, feeling full of ideas and plans, and often an increase in impulse spending or in sexual desire. It does not include delusions, paranoia, or hallucinations that can come with Mania

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Moving Abroad With Mental Illness

Many of you have (kindly) asked how my move to Hong Kong and transition to life here has affected my mental health. This past April, just over a year from when I was diagnosed with Type 2 Bipolar Disorder and a slew of other anxiety and panic disorders, I started a new combination of medications. One is an anti-depressant, and one is for severe moments of anxiety. I had reached what felt like a breaking point in my life and this was the third treatment option my doctor and I were trying.  Within just a few weeks I was stunned to realize that I felt “normal” for the first time in as long as I can remember.

Normal meant I was no longer waking up in the morning with twisted knot in the pit of my stomach before I had even opened my eyes. I no longer entered each day feeling defeated and on edge, like at any moment the tenuous rope of functionality I was holding onto could unravel. Yes, some days I still struggled with anxiety, especially when faced with something particularly triggering. But where my base level for anxiety used to never dip below a 4 on a 10-point scale, even on my most stable days, now I find that many days, my baseline is a 1 or a 2.

The best way I can describe it is that it feels like relaxing your muscles after holding them all in tension every moment of every day for years. Most days this feels like a miracle.

The past few months have objectively been extremely stressful. I think the stress of moving internationally, changing jobs, and being separated from your spouse are things that would cause anyone a decent amount of anxiety.  I don’t deny that there have still been moments where I have been overwhelmed with anxiety and fear. I have also been deeply sad about leaving behind my life in Columbia. But the thing that stands out to me is that somehow, I have managed to cope in a way I don’t think I could’ve done a year ago, or even back in March. And not only cope, but find moments of sheer joy and new excitement for this new life.

I can’t describe my gratitude for this. And at the same time, I have to acknowledge the fact that I am not “cured”. I am on a journey. I am managing so much better than I was a year ago, but it’s not as simple as just popping those two little pills each night. My mental health is a holistic battle and the reality is that it will probably be a lifelong fight.

This past Sunday we visited a church for the first time since coming to Hong Kong. We haven’t really met anyone here besides coworkers, and we are hoping to find a community. Throughout the afternoon I could feel myself getting more and more anxious. By the time we left our apartment, I felt like I was in a daze. Everything seemed a little too bright and blurry around the edges and the sounds around me were like a low buzz in my ears. Jonathan tried to talk to me about other plans for the night and for the future, and I could barely process what he was saying to me. Eventually he gave up talking to me until after the service was over.

After we sat down in the church auditorium (which looked like the church auditorium of many an evangelical church in America), all of my thoughts and all of my energy were consumed with trying to get through the service without panicking. Understand, it was a perfectly normal evangelical-style church service. There was nothing particularly objectionable about it. But for most of the service I felt simultaneously like my skin was on fire and like I was going to pass out. “You are OK. This is OK. There is nothing wrong here,” I kept chanting to myself.

After the service was over, we ducked out and went to dinner where I tried to explain to Jonathan what I’d been feeling but failed (though he was gracious as always). By the time we got home later that evening, I was utterly exhausted. Coming down off of the adrenaline that had fueled me through the afternoon was like crashing after a sugar high. My whole body ached.

Moving abroad has helped move me out of some old patterns that were not good for me. At the same time, it’s launched me into a world of unknowns, a somewhat precarious place for bipolar planner like me.

The thing about mental illness is, it’s effing scary. It’s scary to feel like you don’t have control over your own mind, or that your body has these visceral reactions you may not even understand. It’s scary to know that it’s possible for your feelings to not accurately reflect reality. The fight for wholeness and wellness forces me to choose every single day to actively work towards healing.

It’s a holistic effort. Medication is a blessing, but it is not enough. Meditation, exercise, and diet help. Nurturing life-giving relationships helps. Prayer helps. Avoiding triggering situations helps. Turning off the introspection to show love and care to the people I encounter every day helps. But the thing that helps the most is hope. Hope each morning when I wake up that today can be a good day. It can be good no matter what yesterday was like and no matter what may come tomorrow. Today I can be well.

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PS- I just wanted to give another shout out for my new travel website www.keeproamingon.com. I’m proud of the work I’m doing there and would love to have you follow me if you are interested in sharing my travel and living abroad adventures. You can follow by clicking the follow button at the very bottom of each page.

 

 

 

 

We Must Risk Delight: Or How To Combat the Devil One Tattoo At a Time

Whether we want to admit it or not, we are all bound by routine. Even the most spontaneous of humans cannot escape the cycles of time and nature. Repetition–of the sun each day, of the moon each month, of the seasons, of new years–creates a rhythm to our days. For me, these rhythms always include the ominous beats of depression and the frenzied syncopation of hypomania.

Sometimes depression is triggered by a specific event that I can point to, but most often it creeps over me slowly, the way the sun sinks slowly to the horizon at the end of the day until, seemingly all at once, it’s gone. For me, depression is caused by carrying an excessive amount of pain just as much as it is by synapses misfiring in my brain. When this happens, I am also consumed by guilt. I feel that it is wrong for me to be weighed down by pain and sadness when by most measures I live a safe and wonderful life. It has only been in the past few years that I’ve come to understand that the pain and the sadness I carry is often not my own.

I am a highly empathetic person and I am deeply affected by the feelings of those around me both in my daily life and in the world at large. I am particularly sensitive to their pain and suffering. This is not something I have the power to turn on and off; it is part of my nature. I cannot help absorbing the feelings of those around me the same way a sponge cannot help soaking up whatever moisture it touches. Often, I do not even consciously recognize that I am doing it until one morning I wake up feeling crushed by the weight of it all.

Last year I experienced relatively long periods of depression. In spite of many beautiful moments, the undercurrent of my days was heaviness and sadness. There was so much sorrow and injustice in the world in 2017, and I wrestled with the question, How do I dare experience joy when there is so much pain and so much grief in the world? One day as I listened to Elizabeth Gilbert’s fantastic podcast Big Magic, I heard her quote the poet, Jack Gilbert in his poem “A Brief for the Defense.” It spoke beautifully to this exact question. I immediately found the whole poem and read it in tears at least a dozen times in a row.

A Brief for the Defense
Sorrow everywhere. Slaughter everywhere. If babies
are not starving someplace, they are starving
somewhere else. With flies in their nostrils.
But we enjoy our lives because that’s what God wants.
Otherwise the mornings before summer dawn would not
be made so fine. The Bengal tiger would not
be fashioned so miraculously well. The poor women
at the fountain are laughing together between
the suffering they have known and the awfulness
in their future, smiling and laughing while somebody
in the village is very sick. There is laughter
every day in the terrible streets of Calcutta,
and the women laugh in the cages of Bombay.
If we deny our happiness, resist our satisfaction,
we lessen the importance of their deprivation.
We must risk delight. We can do without pleasure,
but not delight. Not enjoyment. We must have
the stubbornness to accept our gladness in the ruthless
furnace of this world. To make injustice the only
measure of our attention is to praise the Devil.
If the locomotive of the Lord runs us down,
we should give thanks that the end had magnitude.
We must admit there will be music despite everything.
We stand at the prow again of a small ship
anchored late at night in the tiny port
looking over to the sleeping island: the waterfront
is three shuttered cafés and one naked light burning.
To hear the faint sound of oars in the silence as a rowboat
comes slowly out and then goes back is truly worth
all the years of sorrow that are to come.
                         -Jack Gilbert

I still cannot express how much this moved me except to say that I knew immediately I wanted these words with me always. Without a way to burn them into my heart, I settled for inking them into my skin.

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Umm…so it is really hard to take a picture of something on your upper ribs without things going downhill really fast. It is actually straight in real life. Many thanks to my husband/photographer for making this look as appropriate as possible.

This poem gave me the answer I desperately needed, and the fog of depression slowly began to lift. We all have a responsibility to acknowledge the real pain and suffering of others and to do what we can to alleviate it. One way that we fight despair is with delight. “We must have the stubbornness to accept our gladness in the ruthless furnace of this world. To make injustice the only measure of our attention is to praise the Devil.” The question then becomes not, How dare I experience joy in this terrible world? but How dare I not?

More joy in the world is always a good thing. More hope in the world is always welcome. Experiencing peace does not dismiss the reality of suffering. Instead it points out that pain is not the only way, and it calls out injustice as evil. Perhaps the way to fight the devil is the way of the Who’s down in Whoville whose Christmas was stolen by the Grinch, but who sang in spite of it. Perhaps fighting the devil is having the courage to embrace joy instead of letting despair win.

When we see goodness for what it is and we dare to enjoy it, we give glory to the giver of every good and perfect gift. We bear the banner that says Hope still exists. Peace is not a fairytale. Joy is alive. This is a sacred calling. I do not know if this knowledge can ever save me from depression, but I believe that this is true: We must be brave. We must risk delight. We must admit there will be music despite everything. We must cling to Joy on behalf of those who cannot.

“But You Don’t Seem Bipolar” and Other Things You (and My Gynecologist) Shouldn’t Say

Soon after my revelatory meeting with my psychiatrist, I embarked on that most delightful of all womanly privileges, my annual pelvic exam. This time I also had a specific mission – to discuss the potential side effects my being on the pill was having on my mental health and what alternative solutions there might be.

Along with meditation and other anxiety-reducing techniques, one of the first courses of action my psychiatrist recommended was to stop taking oral contraceptives to see if and how these seemed to influence my mental health. Since I have always found myself to be very sensitive to the pill and experienced many side effects for years, it made perfect sense to me that altering my natural hormones might have an affect on my mental health.

As is traditional, the doctor was “running late in surgery,” which gave me lots of time to build anticipation over both the exam and talking about the “b” word with someone outside of my inner circle of family and friends. My anxiety built so much that by the time the nurse took my vitals my blood pressure was high.

(Side Note: When I texted my husband to tell him about the blood pressure spike, he very thought (ful?less?)ly asked, “Why do you think you’re feeling anxious?” To which I sweetly replied, “I think it’s because a strange man is going to stick a metal object with a sharp blade on it inside of me and scrape my cervix.”)

Before the blessed event, I sat across the desk from my doctor (who, for reasons I believe are entirely self-explanatory, my friends and I refer to as “Poor Man’s Matt Damon” (PMDD)) and explained to him, “I was recently diagnosed with bipolar depression and…”

“Really?” he cut in skeptically. “But you don’t seem bipolar!”

I stared at him blankly for a minute, too stunned to think of a response. To be honest, the first thing that popped into my head was “And you don’t seem like a moron…” but thankfully I waited a beat. Finally I said, “Well, I’m pretty sure it’s accurate.”

“Huh,” he said, still not fully convinced.

I continued on, explaining my doctor’s suggestion of getting off the hormonal birth control to see if it made any difference.

“Why would that make a difference?” he pushed.

“Well…I guess…because…your hormones affect your moods. And it’s a mood disorder?” I ventured.

“Well,” he finally said, “I’m not a psychiatrist so I won’t argue with her, but I don’t know about that.”

Initial awkward conversation aside, we moved on to the most glamorous part of the ordeal, in which I put on a sexy gown essentially made of paper towels and attempted to make light, casual conversation with PMMD while he poked and prodded.

“So, I remember that you’re a writer, ” he began, no doubt having read over my chart while I was changing. “So…do you write more when you’re manic?”

I lay there looking up at the ceiling in this most vulnerable of positions, trying to ignore the cold pressure of the speculum and the heat rising to my face. I responded like I always do when I feel uncomfortable and don’t know how to show it. I laughed. I laughed like it was all a big joke. “Yes,” I said. “But of course, I do everything more when I’m manic.”

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While my doctor’s response was especially surprising given his career as a medical professional, the general sentiment is one I have encountered many times. Even before bipolar was part of the mix, I would mention my social anxiety to people and they would say, “But you always seem so confident. I would never guess.” When used to assure me that I can pass as normal in social situations, I honestly do appreciate this sentiment, but I have a harder time when it comes across as skepticism.

When I was first diagnosed, I felt relief and denial in equal measures. I was relieved to hear that this decade-long struggle had a name and that the regular return of depression was not a sign of weakness. In some ways it was empowering to reframe what I had thought of as recurring failure as remarkable resilience.

But as I wrote in my last post, I also had a hard time coming to terms with this word which brought with it stigma, shame, and fear. My awareness of bipolar disorder was limited to the extreme cases portrayed in movies or cited in news stories. While I now know that this disorder is a wide-ranging spectrum with many sub-types and that the experiences of people who fit under the larger mantle of “bipolar disorder” can vary tremendously, my initial understanding of it was embarrassingly narrow.

One of the things that compelled me to start writing about this was the desire to educate other people and to challenge the stigmatization of mental illness in general, and of this one in particular. To share your experience openly and honestly with someone and have them respond with doubt is incredibly invalidating, and it puts you in the strange position of actually trying to build an argument to convince someone of your suffering.

Dear Dr. PMMD, I’m glad I don’t seem bipolar. But that’s kind of the entire point.

How many people around us seem completely fine and are dying inside? How many people paste a smile on their faces while their bellies grow heavy with dread? How many people seem to keep a thousand plates spinning without every dropping one, but wake up in the night with their hearts racing, unable to breathe. How many people have a hundred friends, but no one who really knows them?

It is noble and right to reach out and to ask. But it is our high and holy calling to listen and to believe.