Living with Bipolarism

This was our final term paper. It was easily the most difficult to write. I’m still not convinced it was the best I could have done. But it is what I handed in.

When I dropped out of college and agreed to go into therapy, I knew I had a problem. What I didn’t know was that it would take a year before I could put a name to my problem and another year before I could begin to understand what it really meant. Being diagnosed with bipolar II disorder was probably one of the best things that could happen to me. Now I just have to find a way to live with it.

Bipolar II disorder, once known as manic-depression, is a mood disorder that is characterized by at least one major depressive episode and at least one hypomanic episode. This observation – that moods swing to either of the two polar opposite extremes – gives the disorder its name – bipolar. There are two major syndromes of the disorder – hypomania and depression. Hypomania is the high syndrome of the disorder. It includes mild euphoria, hyperactivity, irritability, an elated mood, increased energy level and rapid thinking and speaking. Often times, bad decisions regarding personal health and financial needs are made. There is a decreased need for sleep and a heightened concentration and thought process.

“As a hypomanic, I didn’t stop to analyze my thoughts, feelings or behavior. I was much too busy and didn’t always stop to think about what I was doing…I was critical of others and occasionally told some people off publicly. I was not so concerned about…the effect my behavior had on others. I was aggressive, talked incessantly and interrupted others while they were speaking. Whenever I had a thought I felt compelled to utter it and I didn’t always censor my thoughts and feelings. At times I seemed to have lost my sense of judgment. I was having a good time, I was narcissistically preoccupied with myself, but (without begin aware of it) I was making my wife miserable.”
– Dr. Norman Endler

The depression syndrome of the disorder is both easier and more difficult to describe and discuss than hypomania. It is easier because almost everyone has gone through a period of depression. That is also what makes is more difficult to discuss: clinical depression is a very different experience from “normal” depression. It includes a relentless, pervasive gloom that continues from one day to the next. Depressed individuals find their thinking dominated by thoughts of sadness, loss, regret and hopelessness. Feelings of guilt, inadequacy and worthlessness are significant and especially common. Severe depression causes changes in sleep patterns as well, not only causing insomnia, but also hypersomnia or sleeping too much. A defining symptom of clinical depression is a condition called anhedonia. It is a general lack of interest in living and in the pleasures of life. The inability to feel pleasure results in feeling pain and suicidal thoughts.

“Healthy people cannot imagine a form of torment so alien to everyday experience. For myself, the pain is most closely connected to drowning or suffocation – but even these images are off the mark.”
– William Stryon

Edwin Schneidman studied suicide and the reasons people committed and attempted them. He came up with a term for the pain described by Stryon. Psychache is the hurt, anguish or ache that takes hold in the mind. It is intrinsically psychological – the pain of excessively felt shame, fear, anxiety, loneliness, angst, dread of growing old or of dying badly. When psychache occurs, its introspective reality in undeniable. This leads to lethality, or the idea that “I can stop this pain; I can kill myself,” which is the unique essence of suicide.

A graphical image of bipolar moods is pictured below. The black line represents a normal mood range, or baseline personality. The red line is the extreme moods of bipolar disorder. Above the baseline is the elevated mood, or mania. Below the baseline is the low mood, or depression. At the lowest point of depression, marked by the blue line, the individual has no energy or desire to do anything, even commit suicide. Suicidal thoughts don’t begin to occur until the person begins pulling out of the depression, and then gains the energy to kill themselves. This is marked by the yellow lines.

I can’t get the graph to show, but I think you get the general idea.

I didn’t know all that when my therapist, Jenny, first diagnosed me with bipolar II disorder. The diagnosis came a year after I dropped out of college and moved back home. My freshman year of college was one of the worst times in my life. My favorite mentor, my high school band director was on trial for sexual relations with a student. My high school sweetheart had broken my heart and I was far away from my family and friends. I didn’t get along with my new band director and my classes were difficult. Upon returning to campus, after spending Thanksgiving weekend with my aunt, I completely shut down. I stopped going to classes altogether. I spent most of my time sleeping or crying in bed, refusing to get out from under the comforter that protected me from the outside world. I wanted to shut myself up in a box. I may have been alone with my pain, but at least I wasn’t experiencing any new pain. I wanted to go home, but my parents weren’t too keen on the idea. My depression gained control and I hit rock bottom. I wanted to throw myself off the roof of my dorm, just to end all the pain. A good friend recalls a conversation we had during that time.

“That December night we talked online, before you came home. You worried about staying at Calvin and telling your parents. You talked about the rooftop…. I thought things were definitely serious then. I don’t know if I’d say what. I just thought you were extremely depressed out there.”
~ Excerpt from Interview with Manny on April 9, 2005

It was one of the first signs that something was really wrong. I was feeling the psychache that Schneidman talks about, and I wanted to find a way to end it. I had been very depressed while away at school, and finally convinced my parents I needed to move back home in January 2003. But I refused to tell them the real extent of my problem.
I didn’t tell them I was having suicidal thoughts until October. I remember the night that finally forced me to tell my mother. It was during what I now know as rapid-cycling, which is going between highs and lows very quickly. I was at a concert with some friends in Poughkeepsie. The bands that were playing were two of my favorites and I had a great time. I was elated and hyper as I drove out of the parking lot. Moments after pulling onto the empty road, my good mood evaporated. The road home is curvy, and I found myself thinking, “I should just drive off the edge of the road. Why bother doing this anymore?” I called a friend on my cell phone and only by talking to him, got home safely. The next day I told my mother. She called our family doctor and he recommended a therapist, Jenny, who immediately put me on an anti-depressant called Lexapro. I started sessions with her once a week. By February of 2004, I felt great. My concentration was at an all time high and I couldn’t rememremember being that elated. I was bursting with ideas and dreams, rushing my words and thoughts into jumbled sentences. Jenny saw this not as a victory over the depression, but what it truly was – hypomania. She changed my diagnosis from depression to bipolar II disorder and my medication from Lexapro to Lamictal. Lamictal, also known as lamotrigine, is used to treat epilepsy and bipolar disorder.

My mother is a big support, trying to figure out what it means for me to be bipolar. She and I have read different books and accounts about the disorder. In therapy, Jenny watches my moods from an objective point of view and has helped me define what is bipolar and what is me. We also talk about high school and when symptoms of the bipolar disorder really started. Incredibly, I can trace the early symptoms of strange sleeping habits, anhedonia and psychache to when I was about five years old. The symptoms slowly but surely built as I got older, until they climaxed at college.

It has been a little over a year since I was diagnosed and I still struggle with learning what it means to be bipolar. The hardest part for me now, is explaining to people about my disorder. They want to know why I’m not in college right away and the bipolar disorder has a lot to do with it. There is a certain stigma that comes with the word bipolar. That stigma makes it hard to admit I have bipolar disorder. Some believe that depression resulted from a character flaw or weakness, and people who are depressed could just snap out of it if they tried hard enough. Being treated for a psychiatric disorder means you have in some way “failed.” I had a friend who wanted me to just think and react like a normal person. He became very frustrated with me when he realized I would never be normal. There is also a Christian idea out there that if you believe enough, God will take this illness away. “After all,” they claim. “It’s really only in your mind.” These attitudes and beliefs make it difficult to tell people about being bipolar.

Another thing that makes bipolar disorder difficult to describe and discuss is the long list of symptoms. The Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV) helps doctors diagnose various mental disorders. The list of different symptoms in the DSM-IV for bipolar II disorder is lengthy and criss-crosses with other forms of bipolar disorder. There is no blood test, or proof-positive way to diagnose bipolar disorder, or any mental illness. Each person diagnosed with bipolar disorder has different symptoms and different ways those symptoms come out.
My hypomania starts with the desire and action of buying things I can’t afford and don’t need, like more CDs and DVDs. It expands until I’m deciding to go away to school and attempt various careers, for example a scientist at NASA or a cryptologist at the NSA. I plan, that while I’m working there, I will also be raising a family and helping the world at large to understand what being bipolar means. After that, I plan to become the first woman president. My dreams are bigger than the stars, but in reality they won’t happen.

My depression usually starts coming out in my writing, like this excerpt from my diary.
I want to cry
And let everything out
In silent screams
And painful breaths
But the lid on this pot
Has been sealed shut
And I can’t seem to open it
I know the longer I wait
The more explosive and dangerous
The reaction will be
And the less reality it will need
To set off the ticking bomb
Soon all I will need
Is a tiny drop of reality
To send me spinning into oblivion

~ Excerpt from 3/28/2004
Diary Entry

The depression builds until I can find pleasure in nothing that I used to love. All that I am left with is this immense pain inside. It is not often I feel such intense psychache, but when I do, I look for a release. By cutting, the pain inside of me is breaking free. Eventually, I reach that point of lethality – where the only way to stop the pain is to kill myself.
“I had every intention of only avoiding further pain which I knew I was inevitably going to experience.”
~ suicide note

Since I’ve been diagnosed, I am more aware of my relationships with other people and how I interact with them. I realize now that when I start becoming irritable, it probably means there is a change coming. If I start to pick a fight with a friend, I can now pull back and save myself and them from the pain of an argument. I also know that I usually do not react to situations like a “normal” person would. My high school band teacher’s actions have had more affect on me than most people realize. It has been almost 3 years since he was arrested and convicted. Yet his betrayal still haunts me and affects my decision to go back into music. I have lost relationships because my friends couldn’t understand why I couldn’t just let the whole issue go. His betrayal was an influence on the beginning of my worst depression. Its something I will never be able to forget. People who don’t understand bipolar disorder and my personal struggle sometimes don’t understand why I can’t just “will it away.” They see me as weak, lazy, or not giving it enough effort. When I experience those reactions, it makes me wary to tell other people that I have bipolar disorder. I don’t want them to think that I am trying to find an easy way out of dealing with life, because its not true. I’m trying to find a way to deal with life, living with bipolar disorder.

Every so often, I’ll take myself off my medication. I might be feeling really great and believe I don’t need the medicine anymore, which is actually a sign of mania setting in. Another reason is that every time I take the pills, I’m reminded than I’m not okay. It’s a daily reminder that there is something wrong with me.

“Schubert was crazy. I wonder if you have to be crazy to make something so beautiful.”
~ Josh Lyman from the West Wing

I know this comment was made in the scene for character purpose and has no real bearing on the way I took it. Still it perfectly explains my biggest fear. I’m afraid that I’m such a good musician because I’m bipolar. Or vice versa – I’m bipolar because I’m such a good musician. This idea that my music and my bipolarism could be somehow mutually dependent terrifies me. Various musicians and artists are believed to have been bipolar, like Tim Burton, Charles Dickens, Leo Tolstoy, Hector Berlioz, Gustav Mahler and Tom Waits to name a few. That’s why I’m constantly running scared from my music. Somehow I think if I stop playing, my bipolarism will go away, or if my bipolarism goes away, I won’t be able to play. Neither scenario is true because neither of my music or my bipolarism is ever going to go away forever. I’m a musician and I’m bipolar. When I’m at what they call a “baseline personality” I’m normal, so to speak. At that point, my playing is average. It’s good, but nothing special. When I’m outside that baseline, my playing is extraordinary and phenomenal. So when I’m on my medication, the baseline is about where I am. And I can’t play. So I go off them, veer off my baseline personality and I’m amazing. The danger is I become suicidal. People think I’m being selfish and stupid for not sharing my gift, my musical talent.

I may have been diagnosed over a year ago, and I may be on my medication now, but all that doesn’t guarantee I’ve figured out how to deal with this strange disorder. A symptom of bipolar depression is the feeling of being alone with no one to understand you. This especially haunts me as I just try to find a way to live through another week. I’ve come to learn and accept that I can’t find the perfect cure or drug to make the rest of my life normal. Every day is another battle, each hour is a new struggle. Some days are easier than others, but they all have their challenges. I’m slowly making my way through them.