I’ve met other autists and other people with bipolar, but I’ve never met another bipolar autist. So today I’ll address what it’s like living with both together, and what I see as the similarities and differences between them.
Let’s start with a rundown of how the two conditions are defined and treated by the medical community. Both are diagnoses listed in the DSM, the Diagnostic and Statistical Manual of Mental Disorders, which lists all possible mental diagnoses and their diagnostic criteria. (It’s quite the tome, but very illuminating to skim through.)
However, autism, or Autism Spectrum Disorder as the latest edition of the DSM calls it, is a mental condition but not a psychiatric or psychological one. It is, in fact, a developmental neurological difference, listed alongside mental retardation. An autist has hardwired differences between her brain and a neurotypical one, though there’s a lot we don’t yet understand about how this works. (I highly recommend a look at Temple Grandin’s The Autistic Brain for interesting details on this topic.) As such, it can’t be treated or removed by drugs or therapy. Certainly, some therapies, like Cognitive Behavioral Therapy, can help a person become more functional, but they do this by instilling new coping skills and healthy behavioral responses, not by removing any part of the autism.
(Side note: Some people may be more familiar with the term Asperger’s. With the recent 5th edition of the DSM, this diagnosis is no longer in use. It, along with Autism and Pervasive Developmental Disorder, has been reclassified in the more expansive Autism Spectrum Disorder diagnosis. For my thoughts on this change, see The sinking of Aspergia.)
Bipolar disorder is something different. It, along with clinical depression and related diagnoses, is a mood disorder, a subset of psychiatric disorders– a larger category that includes everything from addiction to OCD to Schizophrenia. We know that it relates to chemical imbalances in the brain, and that a genetic component seems to exist, but beyond that, not much is understood about its cause. We do know, though, that in many cases it responds well to pharmaceutical therapies like mood stabilizers (Lithium), anticonvulsants (e.g., Lamictal, Tegretol), antipsychotics (Zyprexa, Geodon, Clozapine), and to a lesser extent antidepressants (Prozac, Paxil, Celexa, Zoloft) as well as, in treatment-resistant cases, to electroconvulsive therapy. Most bipolar people experience episodes of euthymia– “normal,” stable mood; neither manic nor depressed– during which it’s possible to see what their personality is in the absence of ravages of extreme moods.
Now that’s out of the way, you might notice that I use different phraseology when writing about bipolar and about autism. This is something I feel very strongly about. I consider bipolar a disorder I have. I consider autism a way I am. Sometimes, people think they’re being sensitive by using “person-first” language to talk about autism, that is, using the phrase “person with autism,” or saying “She has autism.”
To me, this phrasing is not only unnecessarily clunky, but uncomfortable and factually incorrect. To say I have autism implies it is something separate from my innermost self, something I might (and, according to our conventions, maybe should) be “cured” of. This is not true. You cannot take the autism out of the autist. There’s no way to make my brain neurotypical, nor would I want you to. If you somehow magically did, I wouldn’t be me anymore. My brain is my mind is my self, and my brain is autistic. Therefore, I prefer to be called an autist, because I think it’s the term that’s the most accurate and elegant, but I’ll also willingly accept being called “an autistic” or “an autistic person.”
Also, it’s important to note that I don’t consider autism an illness or a disorder, but I do consider it a disability. Here’s the difference: Calling it a “disorder” implies it’s something gone wrong. I don’t think it is. There are things I love about it and things I’m not so fond of, but that goes for my overall assessment of myself and basically anything else. But it is without question disabling for me, because I’m not able to live my best life in current conditions. The world is simply not built for autists, even though a lot of it has been built by us. It’s on those terms that disability and ability must be judged.
Bipolar disorder, on the other hand, I have no problem calling both a disorder and an illness, and when talking about it, I’m fine with person-first language, though I also accept for convenience’s sake being called a “bipolar person.” (“A bipolar” is a bit more iffy and icky.) I know that there is a version of me that is not either depressed or manic, because this was me for the first 11 years of my life– up until puberty and stress brought on my first depression– and it’s even still me occasionally now. Would I cure my bipolar if the possibility were given to me? It’s hard to say, and too hard for me to answer here. But it is at least conceivable. And it is also, clearly, a disability, far more so than autism in my own case. Even if all possible accommodations were given to me, it would still keep me from living the life I desire.
So what’s it like living with both? Confusing! Oftentimes my autism-based tendencies are at odds with what my bipolar is telling me to do. For example, one of the key features of autism is having special interests. For me, these are language and astronomy. I love reading about both of these topics, as well as learning new languages and looking at the stars. However, often I am so depressed that I am incapable of doing any of these things. I try to read, and the words make no sense to me. I’ve had a beautiful large telescope for almost a year, having begged for it as a birthday present from my parents, and I’ve barely used it at all because I’ve been too depressed to get it working properly.
Being autistic also makes me particularly susceptible to stress. I get easily overstimulated by being around too many people or in unfamiliar environments, and I don’t do well with changes to my routine or environment. This is often at odds with my manic desire to be everywhere and do everything at once. In addition, such stress is frequently a trigger of mood swings for me, meaning that I have to be very careful not to exceed my limitations, even when I’m feeling grandiose and exuberant, lest the overstimulation push me into full-blown psychosis or a deep depression.
Several psychologists and psychiatrists have tried to “narrow down” my diagnosis to either autism or bipolar, finding it doubtful that I truly am both bipolar and autistic, having never dealt with such a case before. Those who saw me manic perceived my resultant confidence and doubted my autism. Those who saw me depressed or euthymic perceived my autism and doubted that I was bipolar. However, in Februrary of this year I underwent rigorous testing that confirmed that I do indeed meet all the criteria for both. This may be unusual, but it is the truth.
Another difference is that, by definition, autism has been with me since my birth, or at the very least, since I was quite small. It’s not something that gets worse with age or sets in later in life. I was a weird kid. I’ve always had my special interests, though they haven’t always stayed the same; I’ve always been obsessed with data sets and collecting and organizing information. As a child, I would spend hour upon hour doing things like memorizing all the countries in the world and their capitals and reciting them in alphabetical order, or staying up all night to record all the times the furnace turned on and trying to establish a pattern. I lived largely in my head, and wasn’t terribly concerned with making friends; when I did spend time with other kids, I wanted to tell them how we would play and get them to act out what was in my head, not interact with them as equals.
I was always somewhat moody as well, but true bipolar symptoms didn’t hit me until I was 11. I’d been homeschooled until then, according to my preference to learn more and faster than what school could teach me, without what I thought of as the interference of dull, fussy peers. Then right around the time puberty hit me, I started seventh grade in a public school. It was a disaster. Being autistic manifested almost as a learning disability– I simply couldn’t understand and follow directions, or keep my work in order to turn in. I also started to realize how different I was from my peers, and was deeply troubled by my inability to interact with them the same way they did with each other. I was simultaneously bored, overstimulated, awkward, and clueless.
At the same time, I began to feel more and more deeply depressed. I began a habit of self-harm that would last for years, right up until I discovered alcohol as a destructive coping mechanism. I hated everything about myself. I hated that I was autistic, though I didn’t know the term then or that it applied to me. Suicide hung like a shining star in my dreams, something I didn’t yet have the courage to do but that I felt was inevitable in the long run. All I wanted was to escape from the horror of my life.
A few years later, I was hit by hypomania for the first time, and it was the hugest relief. It’s not that I suddenly had all the social skills I normally lacked, but I felt like I did. I exuded overwhelming and inappropriate confidence– my dad described me as “imperious.” I felt full of life and laughter and excitement. Nothing could hold me back or hold me down. I never imagined at the time that in a dozen years this feeling would progress into psychosis that would fill me with divine light only to leave me hollow, devastated and wishing to die.
Yet throughout it all, I never stopped being autistic. I never lost my tendency to special interests, and I never really got any better at social interactions until I started drilling myself on them as I describe in Autism and friendship. I first learned the term “Asperger’s” when I was sixteen, and while I hesitated to self-diagnose as many do, I couldn’t escape how closely the experiences I read about mirrored my own. It became a special secret I had with myself: that there was something that explained why I was so different, and that I was not truly alone. I think this may honestly have saved my life.
The bipolar diagnosis, on the other hand, came out of the blue and wasn’t applied until I was 22. I’d been experiencing what I now know was irritable hypomania. I would stay up for days at a time writing and writing and writing on a novel I’d been working on, but it felt both good and odd. I tried to talk to my then-husband, who in response was, as usual, verbally and emotionally abusive, so without his support I sought counseling. The therapist I saw gave me my first look at the DSM description of Bipolar II and without hesitation I said, “Yes! That’s me!”
I tentatively brought up Asperger’s, as it was then known, with her, but she brushed it off, assuming that it was an either/or problem, not a both/and one. So I never brought up the topic with a professional again, until in 2012 I saw a new and very excellent therapist, who suggested it to me of his own accord. “What do you know about autism?” he asked me, and I cautiously said, “I know some. I feel like it describes me. But I don’t want to self-diagnose.” So he gave me a reading list and some website addresses, and the end result was that I came out knowing for certain that I was both autistic and bipolar.
I am lucky now to have both a therapist and a psychiatrist who accept who and what I am, and try to be sensitive to my unique needs. I wonder sometimes if there are others out there struggling with the same dichotomies that have long troubled me. I know now that developmental differences and mental disorders are not mutually exclusive, but can add up to something that is special and brilliant; devastating and debilitating; confusing and congruent. I am one among many but also one among few. Bipolar and autism have worked in tandem to make me who I am today, but I view them very differently, and think they should be discussed on very different terms.
One is an illness. One is a brain difference. Both have contributed to who I am today. A bipolar autist; an autsitic bipolar person. The important thing to me is that I understand both, and can with that understanding move on to a better life, which I would never have had, had I listened to those who presented them to me as an either/or. The brain is a complicated thing, a combination of hardwiring and chemicals and habits, and my brain demands a special understanding that few have been willing to tolerate. It’s been hard to learn to understand this, but always worthwhile.
I hope that this exposition can help both those who are bipolar and those who are autistic, as well as, perhaps, the tiny subset who, like me, are both. There is truly no end to the variety of types our brains endow us with. Wherever on any spectrum you lie, there is beauty and pain, life and death, ignorance and awareness. And knowing who you are is the first step toward both change and acceptance.