Let’s talk about Bipolar II Disorder, shall we? Like I stated in my last post, I have had every intention of discussing it here. I wanted to do it within my own timeframe, but there is also a certain freedom in having your hand forced. No more procrastination. No more rationalizations for why now is not a great time to address it. No more clever deflection. Just…honesty.
Like most people who battle mental health issues, I vacillate on when and how to discuss them, and with whom. We like to believe we are progressive. That we are accepting and kind, that we live in a “post-racist” and “post-sexist” society. We are not bigots. We are not judgmental. We understand depression, attention deficit disorder, bipolar disorder, anxiety.
We even fetishize obsessive comIpulsive disorder with reality TV and caricatures in other media. We have autism magnets on our cars. We have carefully cleaned up our collective lexicon to reflect how politically correct we are. Yet we become fidgety and awkward when we have to stare at our own vulnerability when these disorders affect our loved ones or—heaven forbid—us personally.
Like many others, I have traditionally used humor to deflect and dodge how raw and terrified I feel about the issues that are a deeply ingrained part of my psyche, my personality, me. Make everyone laugh, make light of it, and it has less power somehow. Or at least while they are distracted with laughter you can carefully put it back on the shelf where you normally keep it without having to thoroughly unpack it. And then change the subject.
A couple of months ago, I reconciled with my capital-P Person, the man I will marry and who will father my children and with whom I hope to grow very, very old. We both were weary at the time and had gone through some significant personal, mental, and spiritual changes while we were apart. In those euphoric days of reconciliation, we talked at length about vulnerability and what that means to us, and our shared penchant for using humor and sarcasm to ward off true vulnerability. We determined individually and as a team to stop side-stepping the things that made us feel weak and exposed and to instead plant our feet and face them. Talk about them. Unpack that baggage. Hold ourselves and each other accountable. Stop running.
One of the more challenging aspects of that pact has been the effect it has on loved ones. When you take humor out of the equation and talk seriously and honestly about your vulnerability, people tend to flounder. They laugh uncomfortably. I get that, and I relate. I distinctly remember trying to joke with every therapist I have ever met during most of our sessions.
I’m sure my mascara looks AMAZING right now! I’d quip, dabbing at puffy and tearful eyes.
Yeah, I was on my own when I was pretty young. I’m basically like that girl who was raised in a cave. I would joke, daring not to consider how that had made me feel as a teenager, or how it may have impacted the rest of my development.
People definitely want to come over and spend time with me, given the charming atmosphere of my darkened and strange-smelling apartment and my propensity for sobbing and robe-wearing. I would laugh about my sad den of depression.
Good therapists know how to circumvent the humor without making you feel like a complete tool. Not-so-good therapists stare at you silently with a half-smile while you simper and flail.
Vulnerability is not easy. But it is becoming more commonly and widely accepted thanks to the efforts of Brené Brown and others.
For thirty years, I have worn the armor of humor, and for most of my life many people had no idea that there was anything amiss with the chemicals in my brain. Truthfully, I’m not sure if my own father knows that I was diagnosed with Bipolar II several years ago, nor do I know if he is consciously aware of my lifelong struggle with depression. Like many families, we do not talk about such things. Better to leave the lid of that Pandora’s Box firmly closed, lest its contents force us all to talk earnestly about our feelings.
My mother was aware, in tune, and became a great confidante of mine in the last years of her life. But during my formative years when I needed help, when I recognized that I needed help, she struggled. Her own experience with the mental health industry was less than ideal—her mother was in and out of mental hospitals throughout my mother’s childhood.
My own mother checked herself in to an institution when she was around nineteen years old. She had fled a seemingly “perfect” relationship with a great guy from her hometown. He was from the right side of the tracks and could give her the life she would never believe she deserved. They were engaged. Like with most of her relationships, she self-sabotaged…a prisoner to the profound physical, sexual, and psychological abuse she’d suffered at the hands of her uncles and father.* So she ran away, and was certain she would harm herself, and she checked herself in to a psych ward. Then she was trapped there and it was terrible, and she lost her faith in the whole system. She saw another therapist or two later in life, but no one ever really related to her.
So when I went to her as a thirteen year old and then again at fourteen begging her to get me professional help, she didn’t. Even as a child, I recognized that my insurmountable sadness and mood swings were abnormal. I was severely bullied in seventh grade, and my mother believed—hoped, even—that maybe my troubles stemmed simply from circumstances and I could talk it through with her.
Even when I went to her at fifteen and told her point blank that I was certain I was a danger to myself and I needed to talk to someone, maybe even needed to try medication, she refused. We fought bitterly about it. I screamed and cried and raged and acted out. I was labeled “difficult”. I bore the burden of exhibiting “bad” behavior because I was desperate for something, anything, to correct the colossal misery that bled me dry. I was trapped—a hostage to my own mind, and a detainee in a place that would offer me no help.
While my mother struggled with her own depression and addiction issues, I suffered alone, writing in journals and sitting for hours in my closet, contemplating in my adolescent, depression-addled brain how a person might kill themselves with minimal impact on those around them. My mother’s father had taken his own life very violently, and I knew that I could never put my sisters through that kind of pain. But I spent most of my adolescence toying with the idea.
Late at night when everyone was in bed, I would sneak outside to sit in the sub-zero winter, passively hoping to catch pneumonia. I would drink half a bottle of cough syrup, hoping that it might be enough to slow my breathing and take me out. I stole cigarettes and chain smoked, refused to eat, drank only soda. Whatever I could do to maybe cause the end of this existence without having to actually take responsibility for it.
I was a child, alive for just over a decade. And save for a few years in the south, I had lamented being alive for most of that time. As a very young child, my misery manifested as anger. I was perpetually hateful, almost always scowling. I was uncomfortable in my own skin—literally and figuratively. As I became more sentient, humor became my weapon of choice. My best friend D and I would spend hours being completely absurd together. We made tapes of fake radio shows, we chased each other around in red dirt woods, we set up silly performances for our older sisters and parents. He and I remain friends, and he has struggled with depression for most of his life, too. Even when we have not spoken in months, and though we have not seen each other in years, still our souls speak the shared language of sadness.
These days, I have an amazing partner who understands these things. Even when we were apart, he came to sit with me when I didn’t feel safe to be alone. We communicate freely without judgment about the sometimes impossible struggle to just be okay, to find reasons to keep going. He is patient and understanding, and I’m lucky in that I can be completely honest with how I’m feeling. We both can. Imperfections and all, no humor required.
I also have an adult best friend with whom I have a similar relationship. He battles anxiety and depression. Like me, he suffers alone, the way we often do when we are depressed. He has come to my apartment to sit with me when I was not sure I was safe alone. I have taken him food when he was struggling too hard to be healthy. And somehow, when we are together, we laugh.
I think Robin Williams is perhaps the most poignant example of the immovable juxtaposition of sadness and humor.
When we think of Bipolar, we usually think of its former label “Manic Depression”. Movies and television show us highly unstable and energetic characters who have great ideas and stay up for days and go shopping and travel and are very impulsive. And for folks with Bipolar Disorder, often this representation is somewhere near the truth. Someone I know was diagnosed several years ago with Bipolar Disorder, after having days and weeks with so many great ideas that he just couldn’t sleep. That upswing eventually careened back downward, and he was depressed for months. Lithium leveled him out enough to survive, and he learned coping mechanisms that he now must stick to with utter rigidity. The paralyzing fear of returning to that time in his life is incentive to do whatever it takes to stay healthy and normalized, whatever the sacrifice.
That’s one of the funny things about these diseases… even when they’re “managed”, you have to maintain respect for them, you have to acknowledge the unbelievable power they have to absolutely level you. Think of it as electricity; it is never truly harnessed, it is simply redirected and we take precautions to make it safe. But it is inherently unsafe and the danger is always there.
The highs and lows with Bipolar II are not so stark. Often, the disorder goes undiagnosed for years because the hypomanic episodes that characterize it can be difficult to detect. Someone with Bipolar II may be seen and diagnosed simply as a very high functioning depressive. Hypomanic episodes tend to manifest as highly productive behavior.
The wave is strong and motivating, your energy soars, and you are unstoppable in a seemingly stable fashion. And then the wave is over and the depression is bottomless and all the energy has gone elsewhere.
Folks with Bipolar II are functional, sometimes seemingly too functional. We are straight-A students. We hold down good jobs. We have clean houses. We are well-kempt. We are gregarious and fun. It can be baffling to a therapist. The first therapist I ever saw told me very candidly that he did not know how to help me and was not sure if he even could because I was so functional.
Though we are not depressives proper, the life of a person with Bipolar II tends to be marked more by depression than hypomanic episodes. That has certainly been the case in my existence. Until my early twenties, when I first started seeing a counselor and tried selective serotonin reuptake inhibitors (SSRIs) for the first time, most of my life was punctuated by the unceasing buzz of sadness.
But once in a while, the sweet sound of hypomania would break that frequency, and I would suddenly have energy, and could get things done happily and easily instead of with the weight of cinder blocks tied to my every limb. When I first started Lexapro at twenty-three, I had more energy than I had for ten years. I felt alive. I was no longer existing between moments alone when I could cry and sleep.
My hunch is that the right antidepressant will hold steady at that feeling, or maybe something slightly less euphoric but still energetic. I have not yet found the right drug for me. A few weeks after starting Lexapro, I went blind in my left eye and although there was no certain causation or even correlation, all the neurologists I saw were afraid to take the risk. So they took me off of it.
One of the many challenges of a disease marked by episodes of mania and hypomania is that you develop an addiction to the upswing. It is during the upswing that all the feelings that you couldn’t stop feeling at your lowest points can suddenly come out in the form of creativity.
I can write. I can paint. I can sing. I can chase all sorts of creative endeavors and still have energy leftover for personal relationships and work and self-care. My mind is a functional place and no longer has me pinned to the ground cutting off my airway.
I have tried several medications since Lexapro. We have played with serotonin and norepinephrine reuptake inhibitors (SNRIs), benzodiazepines, atypical antidepressants, norepinephrine and dopamine reuptake inhibitors (NDRIs), sleep aids, and mood stabilizers. We have never tried tricyclics. We also have not messed with monoamine oxidase inhibitors (MAOIs), which is especially fortunate because it would be precisely my luck to unwittingly cause my own death by eating a pickle.
I have also tried an obsessive approach to religion, twice daily marijuana intake, and a great deal of alcohol.
Some years are better than others. Some months, some weeks, some days, some hours are better than others. In my case, it can be particularly difficult to manage the depression because my actual life circumstances have so consistently been a shit sandwich that it’s hard to know what’s depression and what’s bonafide grief.
In the final weeks of my mother’s life, we talked openly about our life together when I was a teenager. She sobbed in my arms at what she believed were here failings as a mother. She should not have let her own bias cloud her judgment in seeking treatment for me. She knew that, and I am certain it haunted her for the fourteen years or so until her death.
I would like to say that having Bipolar II does not define my life. But in many ways, it does. Women with this disorder tend to be very sensitive to hormonal changes, so every birth control I have ever tried has had wicked side effects. And when I am off birth control entirely, you could set your watch to the changes in my mood based on where I am in my cycle.
This disorder is one of many of my defining characteristics. Yet in some ways, I am lucky in that I am forced to be hyper self aware. Like a nervous animal, I am always listening and watching, carefully attuned to impending shifts in my mood. It is not ideal. There are moments in my life when I can examine my behavior retrospectively and say without a shadow of doubt that my actions were propelled almost entirely by my disorder. It has taken me a long time to be comfortable with that and to accept it as part of what makes me, me. I continue to adjust, to try and recognize those habit patterns and break them, to not be a slave to my own psyche. But that will be a lifelong journey, one in which I expect I will continue to grow—painful though it may be at times—with lots of help from mental health professionals.
*My mother’s father was physically and emotionally abusive, but never sexually abused her.