Fear of flying

Over time, I’ve learned some of what triggers my hypomanic (and, more recently, full-blown manic) episodes.  I always seem to swing upward in the fall when the daylight starts to change, which is not something I can control, though I do try to modulate it with enforced darkness at night and a sunlamp the rest of the time.  There are other factors that I can somewhat control:  getting enough sleep and food is important, and being active, but not too active.

The problem is that managing my mood swings starts to feel like a full-time job and leaves me with not much time and energy for anything else.  First of all, what does “too active” really mean?  Last night I went to a political meetup for the presidential candidate I favor, and afterward I went to play Magic: The Gathering at someone else’s house.  I really enjoyed both, and when I got home, I felt buoyant energy coursing through me, so that I found it impossible to sleep until about 1 AM, despite taking my sleeping meds several hours earlier.  Then I had to get up early to go to a psychiatry appointment, so I ended up getting 5 or 6 hours of sleep.

Doesn’t sound like that big a deal, does it?  A couple of positive social situations and a couple of missed hours of sleep?  But it is a big deal, because all day, even though I’ve been physically exhausted, I’ve felt more and more manic.  I can’t fully express how frustrating it is that the simple act of enjoying myself and interacting with others for a few hours, or staying up late one night, can cause me to ascend into a manic state.  This state may only turn out to be a couple of weeks of giddiness and productivity, but then again, it might elevate into psychosis and put me in very real danger, as well as tax the patience of the people who have to deal with me daily.

Now, thanks to my mood, I’m in a strange state of waking without being fully present, and even though it’s past my bedtime, I’m incapable of rest.  When I try to lie down and sleep, thoughts swarm so thickly through my mind, like a plague of locusts, that I cannot stand it and must get up to distract myself– by writing this post, as it turns out.  I feel simultaneously irritable and expansive.  I want to see and feel and do everything at once, and yet I loathe everything.  Even though it’s an hour past my bedtime, I’ve opted to drink some coffee and stay awake, because the jittery energy with which caffeine endows me is preferable to being so exhausted yet agitated at the same time.

I deeply resent the fact that there are such potentially serious repercussions to this decision.  I feel like getting out of the apartment to participate in things I seriously care about and enjoy is beyond my healthy capacity.  Too much stress and stimulation.  I start to question whether I can ever have a full, satisfying life, if such minor changes to my routine can cause such a disturbance in my mood.

From there, I start to devolve into self-blame and self-loathing.  I feel that I should be able to do these things, partly because they make me happy, but also because others are able to do them so easily.  I want to contribute to society.  I want to have fun.  I want to be happy.  But my illness repeatedly robs me of achieving these simple goals.  I can’t seem to stay happy without getting too happy.  I have always in my mind the facts that I must not become psychotically manic and that a part of me still hungers for the terrible beauty that mania brings, as well as a heartwrenching resignation to the alternative of being at least moderately depressed all the time.

My euthymia (“normal” mood) is fleeting and fragile.  In the sixteen years since I first became clinically depressed, it never seems to have lasted more than a month, or perhaps six weeks.  That has happened few enough times that I can remember each discretely and count them on one hand.  Add to that a couple of weeks of (hypo)mania each year, and color in the remainder with the cold, black thrall of major depression.

So to me, my (hypo)manic breaks have always been just that: a vacation from what feels like the mundane reality of exhaustion, physical pain, tunnel vision, panic attacks, vomiting, uncontrollable crying, nearly unbearable sadness, hallucinations, fixations on death, drinking binges, and the overall feeling that a thick woolen blanket is wrapped around me, keeping me from feeling or desiring a single thing except to disappear.  I’ve grown accustomed to looking forward to the weeks when I write 200 pages or crochet five projects or exercise 3 hours per day.

Since my psychotic break, I can’t have that pleasurable anticipation anymore.  Every time I feel happy or have a positive thought, I have to check in with myself:  Am I talking too fast for others to understand me?  Am I fixating on something, especially something goal-oriented?  Am I leaping around the apartment laughing uproariously?  Does everything burn too much brighter; feel too ecstatic?  It is exhausting, and it deprives me of much of the non-mood-induced enjoyment I might otherwise experience.

In addition to my policing of myself, I must also deal with the worries of my family and best friend.  They often perceive my mania before I’m willing to admit it even to myself, and from my point of view, they hound me to sleep and eat and relax until I can’t bear the sound of their voices.  I want so desperately to scream at them to leave me the hell alone and stop babysitting me, but most of the time I remain aware that what they are saying contains truth, and that I really ought to listen.

It’s not easy to admit that you can’t trust what your own brain is telling you, and that you must rely on others to tell you what is going on in your innermost self.  If I’m honest, sometimes I do things like stay up late just to show myself that I’m an adult who can do what I please.  Not a very adult reasoning, and I’m not unaware of the irony in that.  But I’ve always been the rebellious one, asking too many questions and trying when I can to circumvent authority.  Sometimes I really want to do things that are bad for me, and sometimes it’s because I know they’re bad.  I know for sure that this is an aspect of why I continually smoke tobacco despite repeated attempts to quit.

I can’t help wondering what kind of future I can have in store if the simplest additions of socializing and contributing to society push me into unhealthiness.  I feel acutely what Stephen Fry claims in The Secret Life of the Manic Depressive, that only 20% of bipolar people are ever able to function at the level they would without the disorder.  (Although I am skeptical about that definition; who knows, after all, who or what we would be without our illness?)

I wonder whether the extent of my life’s accomplishments lies in part-time parenting, writing blog posts, and crocheting stuffed animals.  And that prospect feels hollow and despairing.  I wonder, too, what I would do should, heavens forbid, anything happen to my son.  The only reaction I can begin to imagine is to kill myself, because without him, I really have nothing to live for.

I need more from life.  I need to be able to fill my cup without it overflowing, and as of now, I evidently have not discovered how to strike that balance.  I know that for the foreseeable future I must continue to treat monitoring and regulating my mood swings as my primary goal in life, however disheartening and painful that may be.  I must accept that there is and will be no unqualified happiness for me.  All of my sunshine will carry lengthy shadows.

I’d like to finish by sharing some lyrics from a song I wrote some years ago after a thoroughly unpleasant one-night stand, which I feel captures my problems aptly:

I read the apes stood tall and walked away from the trees

With heads held higher and a sudden desire for fig leaves and apple juice

Well, I was sculpted in an ice hotel,

Far from heaven and I’ve been through hell,

And the breath of life still melts me to my knees.

Like Icarus, I always seem to fly too close to the sun.  There is a burst of glory culminating in a disastrous melting of everything that upholds me.  I either burn hot and fast, or I lay cold and dry as ash.  There is rarely any in-between.  My vigilance must not rest.

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Movin’ on up… and it sucks

I was diagnosed with Bipolar II five years ago last month.  Two days ago, that diagnosis changed to Bipolar I.

For those who don’t know, here’s the difference between the two.  People with Bipolar II have major depression plus hypomania, a milder form of mania that can involve elevated mood, irritability, and behavior that is unusual for the individual but not outside the realm of “sane” behavior and not overly disruptive to their lives.  Until recently, this was me.  When hypomanic, I would spend more money than I should, flirt inappropriately, talk a lot and quickly, and do a lot more goal-directed activity.  It felt great.  It was a fun break from being severely depressed most of the time, and I usually knew when it was coming, as it would surface at certain times of year and then pass on its own after a couple of weeks.  I’d been experiencing these moods since I was a teenager, and no one had ever suggested they were an illness, assuming instead that I was just a very labile teenager.  Some people are very bothered by their hypomania because they get very irritable and have an unpleasant sensation of racing thoughts.  This was rarely the case for me, so I resisted and resented treatment for it.

Full-blown mania is another, though related, beast.  People who are manic exhibit bizarre behavior and thoughts that are clearly outside the norm and are not healthy or safe.  (I wish I could remember where I read this, but I remember someone saying, “People who are hypomanic buy five pairs of shoes.  People who are manic buy 50.”)  It can still feel amazing and in fact I believe it may be the most purely pleasurable experience possible to have; one that people who have never experienced can never understand.  However, one hallmark of full-blown mania is that it puts oneself or others at risk.  Another is psychotic features like hallucinations and delusions.  If either of these occurs, the diagnosis changes from hypomania to mania, and anyone who experiences one full-blown manic episode is considered Bipolar I, and in many cases, the person has to be hospitalized.

Two weeks ago, I started to feel manic.  I knew the markers because I’ve been dealing with this for a long time, and learning about it is how I cope.  I was a little surprised because my hypomanic episodes have always been almost exclusively in the early fall when the light and weather start to change, but I didn’t think much of it, and expected it to be a welcome relief.  For the first few days, it was.  I was energetic, talkative, imaginative.  I played enthusiastically with my son, filled page after page of my notebook with many ideas, talked a lot, and only slept a few hours a night, all of which was basically fine and no danger to anyone.  Then shit got weird, and wonderful, and terrible.

My son had just gone to his father’s (we have joint physical custody) and I was alone in my apartment when I heard the most beautiful sound I had ever heard.  I was paralyzed with bliss.  It was similar to a very large windchime, but indescribably more intense and captivating.  As I froze everything to listen to it, I realized that it was not a tone but a voice.  Unlike any voice I’d ever heard.  It made me ache and wonder inside.  And suddenly everything became clear.

This was the voice of the consciousness of the stars, and without knowing it, I had been waiting and preparing to hear it all my life.  Everything I’d done, everything that had happened to me, was orchestrated for the sole purpose of testing and readying me to receive this consciousness.  It was what I can only call a deeply religious experience, which is something I’ve never had, and is drastically out of character for me, being otherwise intensely skeptical, irreverent and critical.  But it didn’t feel like an anomaly.  It felt like the only real, sensible thing that had ever happened.

My mission, the voice communicated to me, was to prove myself worthy of being chosen as the next in a line of great scientific minds that reached back to the beginning of humankind and included people like Democritus, Isaac Newton, and, my immediate predecessor, my hero Carl Sagan.  Deep inside, it said, I had access to all of their knowledge and memories, but to access those, I must first show that I was ready to receive them.  I had to do this by bringing others closer to an understanding of science and the universe.

So.  How to do that?  Why, social media, of course!  That’s where everyone gets their information these days, and lo and behold, the Facebook homepage was sitting right in front of me, waiting for my divine insights!  So I typed.  And typed, and typed, and typed, and hit enter a lot.  I harassed public figures on inappropriate forums because I didn’t believe they were upholding the legacy of Sagan, and repeatedly exhorted others to do the same, getting myself kicked out of several of my favorite groups.  I wrote stream of consciousness poetry directly into the status box, believing that it would be sacrilege to filter or edit the insights I was given.  I raved on science pages about my visions of the future of space exploration.

In addition to the bell-like, serene voice of the stars, I realized that I was being bombarded with other, more subtle messages, which I had just been missing until now because I wasn’t ready.  Certain wordings in science articles were clues to me about meaning and purpose and what I should be doing.

The whole time, I interspersed this unstoppable flood of ideas with sprinting around my apartment and halls, laughing maniacally and waving my arms around.  When I went outside to take a “walk”, one of my neighbors noticed my bizarre behavior and stopped to ask if I was drunk.  Taking great umbrage, I assured him that I was both safe and wonderful with enough force, insistence and annoyance that he eventually gave me a cigarette and his phone number, told me to call if I was in trouble, and left me alone, at which point I went back inside and resumed typing faster than ever.  (I am deeply grateful to my neighbor for not calling the police on me.  It’s probably for the best that he attributed my insanity to substance abuse, which oddly has less stigma than being mentally ill, it seems.)

And then, by the end of Monday night, it was over.  All at once.  The most wonderful experience of my life evaporated instantaneously like water on Mars and I was left alone like an empty husk with no soul, no purpose and no joy.  I was devastated.  I pleaded the stars to take me back, to forgive me for failing them.  Then it dawned on me, as my mood fell, that everything I had just experienced was nothing but a byproduct of my fucked up brain.  I began to cry, and cry, and cry.  I cried for hours while I read back over all of my rantings and began to understand the damage I had done to my public image and friendships– which are few for me, and therefore very valuable.  I had never hated myself so much or wanted more to disappear.

I could only think of two ways to escape from this harsh re-entry to reality and exit out the other side into despair.  One was to kill myself.  There were easily accessible ways to do it, and I wasn’t afraid.  But I am a mother before and above anything else, and I decided long ago that nothing, no matter how miserable, will make me leave my son motherless.  I know too much about how much this devastates a child.  So I took the second route, drinking myself into oblivion.  I drank and slept for two days, then went through a long and excruciating alcohol withdrawal, and continued on into a horrifyingly black depression, made more monstrous by its juxtaposition with the most terrible beauty I had ever known.  Paranoia took over, and I paced and wrung my hands, convinced that the police were going to beat down my door, restrain me, commit me, and sedate me.  I begged my friend to tell me that he wouldn’t let them take me.  I resisted telling anyone exactly what I had just been through, believing they would use the excuse to commit me.  When I thought about my mania, I didn’t know whether I was more fearful that it would return and further wreck my life, or that it would never return and I would never know that penetrating, reasonless ecstasy again.

As the withdrawal eased up and my friend and parents became gradually aware of what had taken place and reasoned with me about it, I began to really take in the fact that I was experiencing severe, rapid mood swings that were psychotic in nature– delusions of grandeur and reference; auditory hallucinations; paranoia– and that I needed more and better treatment.  Luckily, I had an appointment with my psychiatrist, who is one of the kindest, most competent people I know, coming up very soon.  Though terrified of what she would say, I went in, with my best friend as moral support, and told her honestly what had occurred.

My trust in her was rewarded.  While she did exhort me to go to the hospital if I ever became psychotic again (though I’m still not sure how I’m supposed to recognize that while it’s happening) she did not try to commit me there and then.  She instead supplemented my usual regimen of mood stabilizers, antidepressants, anxiolytics and sleeping pills with a low dose of an antipsychotic medication.It was none too soon, because the next day, I began again to show signs of mania.  I began jumping, running and skipping around the apartment whistling and laughing.  My thoughts and voice raced and shouted and interrupted each other.

I was again torn between my passionate desire to commune again with the stars, and my humiliation and having been witnessed in such a state; my fear of being committed.  Fortunately, I was still just rational enough to say to my friend, “I think I need to take my Zyprexa.”  I did, and after a while, it began to calm me, leaving me confusingly drained, sad, still hyper, and relieved.  And that’s where I remain today.

While I was at my psychiatry appointment, just before leaving I said tentatively, already knowing the answer but needing to hear it out loud, “I know my diagnosis has always been Bipolar II.  So…?”

“This is Bipolar I,” she said quickly and definitively.  My heart sank, even though I’d seen it coming– I’ve read the DSM criteria; I knew that only full-blown mania explained my experience.

“That’s what I was afraid of,”  I muttered.  When she asked why, I admitted, “I’ve always been comforted knowing I was just a little crazy.  There’s so much more stigma attached to Bipolar I.”

And there is.  Bipolar is a fad right now, it seems, perhaps the next Adult ADD or primary postprandial hypoglycemia, and a lot of people are of the attitude that “Oh, we’re all a little bipolar, I have mood swings too.”  Well, now it was clear that I wasn’t “a little bipolar,”  I was a lot bipolar.  I was the type of person who would have probably been locked in an asylum and drugged forty years ago.  Even though it had been brief, I had gone mad.  I had broken with reality, and it would probably happen again.

I worry about my ability to comply with taking my antipsychotic.  An acquaintance of mine who romances psychedelic drugs told me recently, “When you’ve tripped once, everything changes.  When you’ve tripped a lot, everything changes again.”  Well, once you have heard the voice of the stars, once you have communed with the universe and felt the wholehearted, incontrovertible truth that you are the most important person in the world, set apart since before your conception, there’s a place, a pre-psychosis, to which you can never go back.  I still don’t know what that will mean for the years ahead.  I only know that, more than the fear, more even than the shame, I feel heartwrenching melacholia and loss that until now, I could have never understood.

A pocket guide to mood swings [trigger warning]

For all your mood swing identification needs.

Possible responses to breaking a glass:

  • Manic:  “Fucking fuck, I do not have time for this, I am TRYING to get things DONE if everything would just stop getting in my WAY for half a goddamn minute.  I am too smart and too important to be cleaning up fucking GLASS.”  Kicks the floor, stubs toe.  Stays up all night researching what kinds of glasses are least breakable, while also doing an intense workout, watching TV, listening to the radio, reading articles, being pissed off with the TV and radio and articles, and hatching plans to hop a freight train going West and subsist on itinerant work for a year.  Buys an expensive set of “unbreakable” glasses.  Walks on the glass and doesn’t notice cut feet until they become infected.
  • Hypomanic:  “There is a reason I broke this plate.  I just need to figure out what it is and it will change my life.  This gives me a good opportunity to clean the floor, now that I’m down here it seems very dirty, and while I’m at it I’m going to wash the walls and windows and disinfect everything, cleaning is fun, woohoo!”  Puts on loud music and skips around cleaning the entire place while coming up with hundreds of creative ideas; rushes to try to pen them as fast as they arrive.
  • Depressed:  “Fuck, not again.  Why does this always have to happen?  I am such a clumsy retard.  Now I have one less glass, which means I’ll have to wash the dishes more often, and I’m going to have to spend hours cleaning this mess up and probably still end up with glass splinters in my feet.  You know what, fuck it, I can’t deal with this right now.”  Huddles on the couch under a blanket pretending to watch TV.
  • Very depressed:  Bursts into ragged sobs and runs to hide in bed, overwhelmed by the horror and absurdity of the world.

Thoughts on being asked to a party:

  • Manic:  “I’m trying to WORK here and you just made me lose track of the ineffably brilliant train of thought I was following.  If you can’t keep up, at least get out of the way, why can’t you understand how important this is, it’s all so simple!  I guess you just aren’t chosen like I am.  You can’t know what I know.”
  • Hypomanic:  “Yes!  Let’s go dancing!  Let’s stay up all night and go trestling* and come up with a theory of everything!  You’re the best, and I’m pretty great too!  I don’t even need sleep or food!  Everything is fantastic!”
  • Depressed:  “I really want to go and have a good time.  It’s not like people ask me to things very often, because let’s face it, I’m pretty shitty really.  But I know if I get there I’ll feel alienated and anxious and will freeze up and turn red all over and sweat like crazy and have to leave right away, which will be humiliating.  Great, not likely I’ll get invited to anything soon since I’m declining this time.”
  • Very depressed:  “They’re only inviting me to make fun of me, or out of pity, or both.  If I go, I’ll just ruin it for everyone else.  Why am I even here?  What’s the point of all this?  Sometimes I wish I could put a bullet through my brain just to make it stop hurting so much.  I wish the sky would just open and swallow me up and no one would ever even know I existed.  Going to a party is the most miserable thing anyone could do.  If people see me they will hate me and I won’t be able to stand it.”

Manner of speaking:

  • Manic:  Fast enough to be nearly unintelligible, with thoughts streaming out faster than anyone can keep up with.  Total inability to control speech.  Replete with swearing and offensiveness, without a thought for the consequences.
  • Hypomanic:  Fast, boisterous, difficult to interrupt, fixated on special interests.
  • Depressed:  Slow, flat, filled with sighs and groans and more complaining than intended; visible lack of interest in interaction coupled with a yearning to be understood and reassured.
  • Very depressed:  As little as possible; muttering.

The bottom line:  Next time you see these symptoms, know that they are not personal and in no way reflect on you as a friend, partner or family member.

There is no question that bipolar people are difficult to know and care for.  Our experience is often described as a roller coaster, but that’s really too tame.  It’s like a roller coaster where every inch ahead is shrouded in impenetrable fog, and most of the time when you go down a hill, which, of course, always happens eventually, your car smashes to bits and you have no choice but to rebuild it from scratch and get back on, or throw up your hands and walk away.  Half of us will try to kill ourselves at some point in our lives.  Half of those will succeed.

By recognizing what traits are affected by our mood swings, though, you can learn to see the person underneath the mood, or so we hope.  We’d like to think it’s worth the effort.

To paraphrase Season 8, Episode 1 of the rebooted Doctor Who, no matter how scared you are of others’ mental illness, they will always be more scared than you.

*The hobby of climbing a train trestle as a train passes over while yelling and holding on really tight.