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.

Into the mix

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 meit 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.