I will soon be writing a multi-part journey through my experiences in therapy, so I’ve been thinking back on my frame of mind the very first time I started getting psychiatric treatment. Twelve years ago now: not far off half my life. At the time I received a very strange diagnosis, which neither I nor any subsequent practitioner has been able to understand, of PTSD. Talking about it in the interim, I have always let the assumption rest that I was in fact having my first major clinical depression. Which I was, without a doubt. But chewing on it more recently, I’ve started to suspect that what might have been going on was the moody thing less unpleasant than major depression: my first mixed episode, and hence, the beginning of my bipolarity that would go undiagnosed for another 9 years.
And what a lovely coincidence it is. Truly splendid. Because I have an awful tooth-aching feeling that such a phase is bearing down on me as I write.
I am diagnosed with Bipolar II, and spend the vast majority of my time being depressed. I don’t mean just that I have more “downs” than “ups,” but that literally about 45 weeks out of the year I will fit the criteria for major depression. Out of the remaining weeks, perhaps 4 will be spent in hypomania. That doesn’t leave a whole lot of time to be “normal.” The “II” caveat in the diagnosis means that I have never had a case of full-blown mania, only its milder cousin Hypo. As such, the descriptor for my mixed phases is “agitated depression,” but that minimizes their danger and misery much more than the term used with Bipolar I, “dysphoric mania.” Either way, though, what it really means is meeting the standards for a (hypo)manic and a depressed episode at the same damn time.
That doesn’t mean “in the middle.” It means being ripped down the middle. With all the blood and guts you’d expect. If it’s not clear yet why that would be the worst of all possible moods, let me elaborate by breaking down how I feel right now.
Typically, when very depressed, I will spend a whole lot of time lying down. It will be difficult to get out of bed, and when I do, it will be to slump to the couch and watch TV, until I’m too depressed to care about that either. If I’m hypomanic, on the other hand, I’ll hop out of bed after 4 to 6 hours of sleep, make breakfast, and start compulsively and single-mindedly working at something that seems very important, like cleaning the house, making 10 pages of notes for a blog post, or outlining a grand plan for a vacation several years in the future. Right now, I am sitting on the couch with 10 tabs open on the computer with different subjects I feel are very important, including this post. I don’t have the energy to get up and do anything, but I’m trembling all over and can’t sit still. I’m dancing my feet around so much that the cat can’t convince herself they aren’t little animals to attack, and not because I’m excited or even anxious but because it feels like my muscles are trying to crawl out of my exhausted body.
I’m particularly exhausted because of my lack of decent sleep. I am taking an antipsychotic to make me sleep at all, but unless I had trained myself to lie down in bed against my instincts, I would stay up until 3 in the morning doing what I’m doing right now, and being miserable. So I take my drug and I go to bed and after a while I fall asleep; then I promptly go into epic dreams that seem to last the entire time I’m supposed to be resting. 5 or so hours later I wake up shaking and sweating, and I can’t immediately drag myself out of bed because of my sense of dread, but I also can’t ever get back to sleep, so stay in bed breathing hard and grinding my teeth until I can’t bear it anymore and get up and walk around in a strange nightmarish fog, too tired to think, too awake to rest.
There’s also the fact that I’m starving myself, especially given the increased metabolic need created by my constant tensing and agitation. When I’m hypomanic, I will perhaps go on a strict diet, or I might become obsessed with learning dozens of new recipes from a specific cuisine and spend all day cooking. Either way, I will likely be very, very concerned with what I am and am not eating. When I’m depressed, I don’t give a fuck. I’ll lie here feeling starving but without the wherewithal to do anything about it; or I’ll forget that food exists and lose 10 pounds. Now, mixed, I am gnawingly hungry and would really like to eat and I keep intending to get up to get food, but at some point along the way I stop. Either I go to the kitchen and stare at the food unable to comprehend what it is or what to do with it, or I stand up and forget where I’m going and stay there rigid until I snap out of it, or I go to get up but a sudden paralytic horror overtakes me and I instead sit here digging my fingernails into my palms while thoughts blacker than you can likely imagine hive and swarm in my head.
That swarm is, in itself, the worst and most characteristic aspect of mixed episodes for me, and probably the single best way to sum them up. All of the racing, uncontrolled thoughts and multifarious ideas of “regular” mania. All of the despair and self-loathing of vanilla depression. Spliced together like a demonic chimera. At this point, many Bipolar I patients would report crossing into full psychosis, believing that they are tortured by agents of Hell (one acquaintance of mine describes having been convinced for eight straight months that she was possessed by Lucifer and must either be exorcised or kill and mutilate herself. She eventually turned to meth to cope, and I can’t say as I blame her.) Maybe it’s a product of delusions of grandeur– feeling you are uniquely important and powerful– colliding with the depressive belief that you are irredeemably bad. I suppose I should feel fortunate that I only wake up with the fear that there are corpses hanging from my ceiling; the sensation that the shadows in the corners of the room are closing in around me; I only have dreams that I am being chased through an asylum by a psychopath. These thoughts don’t cross over into true delusions or even hallucinations; they are “merely” obsessive. From a subjective perspective, that’s plenty bad enough, thanks. I don’t really want to dwell on what it would be like to go beyond, to have a psychotic break, partly because I have a terror that it may someday happen.
One of the few ways this manifests externally– due to my practiced and maladaptive art of concealing whatever is really happening to me– is through rage. I hate myself right now and I hate everyone and everything. I confess to having violent outbursts against a partner in the past, before I was diagnosed or knew anything about a mixed episode. Thankfully, it has been many years since I stooped to that low, and I believe with my current knowledge I can cope well enough to hold myself back from that, although I’m a little less confident about my ability to keep self-harm at bay, despite the constant effort I make. I can’t abide being interrupted from what I’m doing, even though I can’t, myself, keep track of what that might be for more than a couple of minutes. (So far, I have worked at this post off and on for about three hours, as near as I can reckon. A large part of that was spent simply trying to reread and understand what I’ve already set down, correcting abandoned thoughts and errors of syntax, then struggling to compose a new sentence or two that somehow follows from it, and rereading again, and so forth. Why do I bother, then?– Firstly, because my dysphoric energy demands SOME outlet, however impractical; secondly, because I still retain a conviction that it is very important for me to set down this experience while it happens, because I know whenever it ends I will have lost a large part of its seriousness, partly as a protective mechanism, as with any trauma.) Anyway. Everything that happens makes me feel like a wild animal. But when I do get my surroundings “peaceful,” the commotion in my head deafens me, and I want the distractions back. It’s an impossible dilemma that I can do nothing about except ride it out, trying to hurt the people around me as little as possible.
The difficulty of that admission can hardly be gotten across. I’ve gradually learned to be more open about my depression and ask for the help I need; not to minimize its severity out of pride and shame. To a lesser extent, I’ve started to admit when I’m hypomanic so that those around me can be alert to the risks of impulsive behaviour. Writing or talking about mixed episodes– particularly as relatively infrequent as they are, occurring perhaps once every couple of years– is still the hardest and most painful thing. They are so far outside the realm of what almost everyone I know experiences, without the awareness increasingly awarded clinical depression and, more recently, mania (which is often dangerously glamorized.) They are frightening to me and I know they are frightening to others, because my symptoms sound so bizarre, and now is when I have the most potential to hurt others– not physically, but by lashing out verbally, being cruel and manipulative and intolerant, and absolutely withdrawing from everyone who cares. I am terrified that people will want to commit me (conditioned by the way that’s hung over my head for the last three years or so) or will not leave me the fuck alone. Even stronger than usual right now is my horror of being Supervised, Worried Over, Pitied. If people sstart to treat me that way, I’m genuinely scared that I will either claw myself and let out a long piercing scream, or run like hell which almost certainly equals being committed. There a lot of reasons for this phobia of concern, which I will have to go into at a later date. Suffice it to say that writing this post is an awful and frightening experience because I’m waiting for the shit to hit the fan, the phone calls, the impromptu visits, the troubled looks, and eventually– because it always does come– the blame and resentment. Feeling depressed doesn’t seem so blameworthy, because it’s kind of like being sick with the flu for a really long time, which is at least relatable. And being hypomanic isn’t that worrisome, except when I spend more than I should, which isn’t a matter of serious danger; and not that upsetting (certainly not for myself, who am looking at life as a field of golden sparkles) except when I’m loudly rambling on without making a whole lot of sense to anyone else. But anger is simply unacceptable. It’s thought of as a poor choice, something everyone has to learn to control. And because people can’t fathom my experience, they also can’t understand why I feel so much rage or how painful it is for me; it just comes across as a personal insult and attack. I can call my mom and say “I feel too rotten to take care of my kid because I can’t get off the couch.” I can ask Person of Interest to take over for a while because I have to go nap. But I can’t bring myself to say that I need to be alone because anyone who is here will bear the brunt of my unleashed bitterness, bone-slicing irony, and contemptuous gaze. Instead, I just try to suppress it all inside me like a pressure cooker, desperately clinging to miniscule outlets like repeated smoke and bathroom breaks and letting my son watch way too much My LIttle Pony, begging for this phase to pass before I become unbearable to myself and others. It’s at this time that I am most vulnerable to a relpase of alcohol abuse, and to going so far with that abuse as to seriously harm my body. Right now I can’t afford that, which seems to me a desperately needed modicum of relief, because I’m in intensive outpatient treatment that requires a daily breathalyzer, periodic urinalysis, and a stipulation that should I relapse even once, in any amount, I will either be transferred to a restrictive residential program, or dismissed from treatment, neither of which is tenable. I hate to sound arrogant or condescending, but truly, unless you are one of the rare people who has been where I am, you can not POSSIBLY comprehend the amount of self-control, to the extent that it feels like flagellation, that this effort requires. It is way beyond trying not to scratch an itch. It is submerging your face in a bowl of scalding water and, by sheer force of “will” (whatever, as Nietzsche and I would question, that outdated concept signifies in the first place) not allowing yourself to come up for air. It is sawing your own legs off with piano wire. It is plucking out your own eyes. So when all of you are judging me and saying I’m not fit to be unsupervised and that my meds aren’t working and that I’m a crazy fucking cunt, when you’re being disturbed by all that I have written– remember THAT. That I am doing a more difficult thing than you have ever done or will ever likely do. That I am succeeding where 99.9% of people would fail. That I am exercising every fibre of my being, every ounce of concentration left in my frayed body, to protect others and, for their sake, protecting myself.
That, in itself, begins to let the rage shine through, because it sounds like I am attacking others. Maybe it’s true that, in this one safe anonymous space, I am allowing my anger to reveal itself. But I am also simply being frank, because I want to give honest voice to an experience that is almost impossible to communicate, while at the same time reminding people with stable moods not to ostracize or pass judgment on what and who they don’t understand. I firmly believe, because of the unjust treatment I have been subjected to, that up until the point of psychosis, the adult mentally disables should continue to have their beliefs, desires, and self-determination taken very, very seriously. This post is my way right now of advocating for civil and human rights. FYI, the clock now stands at about five hours of work. Please, I beg of you all to take this seriously and pass it along, even if you normally ignore my blog. It is not just important to me. It is important to every bipolar person, and by extension, to the entire mentally ill and even the entire disabled community. I guarantee you all know and love someone with mental illness, even if you don’t know it. Don’t fail us.
NB: I want to adamantly point out that this post is NOT a “cry for help,” a threat, a statement of suicidal, aggressive, or self-harming intention, or any such thing. It is a piece of self-expression and disability advocacy, nothing more or less.