I’m not especially good at writing personal narratives, but I feel like I should share my experience with bipolar disorder. Today is World Mental Health Day and as I’ve considered writing this blog post in the past, today seemed like a good day to do it. I am hoping that it will help you to understand bipolar disorder a little better. Maybe get rid of some stigmas. Maybe help somebody who has been struggling with something similar. Or maybe none of these things will happen, because I’m just a romantic.
People tend to skip over things on their Facebook feeds about mental health, I’ve noticed. It’s easily dismissed in our culture for some reason, like it’s imaginary or as ridiculous as the ideas of the wingnut birther friend you have. It’s sad that we feel this way, as 1 out of every 4 people has at least a brush with a mental health problem. From anxiety to schizophrenia, you know someone who has one of these issues of the mind. And they’re not imaginary.
I’ll be telling you about just one of these mental illnesses. Bipolar Disorder.
Let me give you some background here. The earliest advent of bipolar disorder in my family, that I know of, was with my great-grandmother – Sylvia. She was committed to a mental hospital at a young age, so presumably she had Bipolar I, perhaps with psychosis, if it was bad enough to be committed. I don’t know. Apparently, back then there wasn’t good enough treatment for her to remain free. I can only imagine how hellish that was for her, as being committed was pretty much like being in jail. For the rest of your life. Her daughter, also named Sylvia, was adopted to another family. I’m not sure if it was related to great-grandmother’s mental illness or not, but probably.
My grandmother, Sylvia, was diagnosed bipolar as well. She took lithium for it, but either it didn’t work well enough or she went off of it, as she had some troubles with the disorder (she was bipolar I, I will explain more about what happens with the disorder later) and eventually, when I was a young girl of about 4 years old, took her own life. Devastating to everyone.
My own mother went through much of my young life thinking she had depression. She took medication for it, but this did not help very much. When you have bipolar disorder, taking depression medication alone can aggravate your condition, instead of helping it. She was often tired, she had a hard time dealing with it and was eventually hospitalized for it several times. Finally, when I was a teenager, they put her on lithium (a mood stabilizer) and it helped a lot. She eventually went on to have ECT and has changed medications and is just now starting to feel completely better.
Now here’s a description of bipolar disorder.
There are two types of bipolar disorder: bipolar I and II.
Bipolar means that your moods have “episodes” that are manic or depressive. For most people, this means a few times a year, they will have a period of a few weeks where they are manic and a few more weeks where they are depressive, or for most of the year they are depressive, with bouts of manic moods, or vice versa, but their moods don’t swing often. If they aren’t having an episode they are normal. For some people, like me, who have rapid cycling bipolar, they have mood swings every few weeks or days. For a few days, I would be manic, then for a week, depressive.
Here’s a good description from http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
Signs & Symptoms
People with bipolar disorder experience unusually intense emotional states that occur in distinct periods called “mood episodes.” Each mood episode represents a drastic change from a person’s usual mood and behavior. An overly joyful or overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression. This is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode.
Extreme changes in energy, activity, sleep, and behavior go along with these changes in mood. Symptoms of bipolar disorder are described below.
Symptoms of mania or a manic episode include:
Symptoms of depression or a depressive episode include:
- A long period of feeling “high,” or an overly happy or outgoing mood
- Extreme irritability
- Talking very fast, jumping from one idea to another, having racing thoughts
- Being easily distracted
- Increasing activities, such as taking on new projects
- Being overly restless
- Sleeping little or not being tired
- Having an unrealistic belief in one’s abilities
- Behaving impulsively and engaging in pleasurable, high-risk behaviors
- An overly long period of feeling sad or hopeless
- Loss of interest in activities once enjoyed, including sex.
- Feeling tired or “slowed down”
- Having problems concentrating, remembering, and making decisions
- Being restless or irritable
- Changing eating, sleeping, or other habits
- Thinking of death or suicide, or attempting suicide.
Bipolar disorder can be present even when mood swings are less extreme. For example, some people with bipolar disorder experience hypomania, a less severe form of mania. During a hypomanic episode, you may feel very good, be highly productive, and function well. You may not feel that anything is wrong, but family and friends may recognize the mood swings as possible bipolar disorder. Without proper treatment, people with hypomania may develop severe mania or depression.
Bipolar disorder may also be present in a mixed state, in which you might experience both mania and depression at the same time. During a mixed state, you might feel very agitated, have trouble sleeping, experience major changes in appetite, and have suicidal thoughts. People in a mixed state may feel very sad or hopeless while at the same time feel extremely energized.
Sometimes, a person with severe episodes of mania or depression has psychotic symptoms too, such as hallucinations or delusions. The psychotic symptoms tend to reflect the person’s extreme mood. For example, if you are having psychotic symptoms during a manic episode, you may believe you are a famous person, have a lot of money, or have special powers. If you are having psychotic symptoms during a depressive episode, you may believe you are ruined and penniless, or you have committed a crime. As a result, people with bipolar disorder who have psychotic symptoms are sometimes misdiagnosed with schizophrenia.
People with bipolar disorder may also abuse alcohol or substances, have relationship problems, or perform poorly in school or at work. It may be difficult to recognize these problems as signs of a major mental illness.
Bipolar disorder usually lasts a lifetime. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of symptoms, but some people may have lingering symptoms.
For me, a stressful period of time just this last year triggered it, so I’m a late diagnosis. One day I would feel great. I would be super happy and excited and the world would be beautiful and my kids so cute and I would get a hundred things done and I was super mom and I loved everyone and I’d buy all the things that we needed and I’d try to get Andrew to let me do things like renovate the kitchen and I couldn’t sleep at night because my mind was going a mile a minute and I was obsessed with researching random things and yes, maybe TMI, but sex was prominently on my mind and every man was attractive (yes. this is embarrassing, but now that I know that it was the manic period talking, I will share this even though it’s hard to. I felt extremely guilty about this, but couldn’t seem to make it go away, no matter what strategies I tried. 😛 )
Then a few days later, I would be so tired and the day would drag. I’d want to sleep all day and I’d take several naps if I could get my children to play outside. I seriously hated my children, my life, and sometimes my husband and would think about things like adopting out my kids or divorcing over Andrew not doing the dishes (WHAT????? YES. IT MAKES NO SENSE.) I’d want to disappear or in some cases, think about/plan suicide (not every time I had a depressive period, just sometimes). I couldn’t remember common words that I knew that I knew, 4 or 5 or more times through the day. I couldn’t remember names of people I knew. I had a hard time explaining anything or staying on track when I was describing things. I couldn’t remember hardly anything about the day previously. I couldn’t focus on reading. I would be mean to everyone and snap at them or spank them for things I normally wouldn’t. I did force myself to take care of my kids with food and diaper changes and stuff, but beyond that hardly anything. I would read my scriptures and pray a lot during the depressive periods, but heard nothing. Felt nothing. Was pretty sure God hated me or, more probably, just didn’t exist since I was doing what I was supposed to and there was nothing. I was praying to figure out what was wrong.
And I couldn’t figure out what was wrong with me. I kept researching brain fog and thought maybe my eating or exercising habits needed to be changed… I was exercising three days a week though, eating a healthy vegetarian diet, and had been for a year. And then, one day, after book club, I was chatting with my friend about things (I was in a depressive period) and the subject of bipolar disorder came up, as she was dealing with it. I asked her some questions about how she felt during the episodes. A light dawned. Waaaaaaaiiiiiiiit a second, my mom has bipolar disorder. Her mom and grandma had bipolar disorder. My sister and brother had bipolar disorder. OH. Yeah, your brain does not work or make connections very well, when you’re in the midst of the disorder (it felt like my problem solving abilities had gone out the window). I looked it up on the internet. Check. Check. Check. Yep, bipolar II (that means your episodes aren’t as extreme as someone with bipolar I. Like, I didn’t go seek out an affair, or spend $1000 on a dress or actually carry out my plans for suicide or anything. Instead, I just was eyeing random guys despite the fact that I adore my husband and he’s fantastic, and spending hundreds of dollars on things we “needed” for the house and planning suicide). Also, this was a direct answer to my prayers. I seriously was getting to the point where I was for reals done with it all and just at the right time, my friend helped me see what I needed.
And this is why watching your friends/spouses for signs of disorders is important. Sometimes it’s hard to know what to do when you’re having mental problems. You feel like it’s probably something you’re doing wrong, that you can fix without help. You feel guilty about your behavior and worried. You know that most people think that people just don’t try hard enough to self-help and they just go on meds for a crutch. A simple word from a friend, a kind suggestion to “have you seen a psychiatrist to see if they can help you out? My friend knows a good one…” can go A LONG way. Or if you struggle with a disorder, not being afraid to mention it. So others know they’re not alone.
So anyway, now came the hard part. I didn’t want to have bipolar. I thought my mom had it because she didn’t exercise, or eat right, or go outside enough or cooperate with the therapists she’d seen. Or she didn’t read her scriptures and pray enough. Or whatever. It was totally curable with fish oil, sunshine, exercise, therapy and proper food intake, right? And it went away, right? After some research, I realized that it was actually 99% a lifetime disorder. That people get the idea after they’re on medication that they don’t need it anymore because they feel fine. And then they swing into a major depressive episode and kill themselves. Yeeeeaaah. Never ever ever ever ever imply that anyone on medication should go off it. Their doctor and them alone are the judges of that. It’s ok to make suggestions of augmentation (Do you want to come running with me? This MIGHT make your medicine work better!) but you can do some real damage implying that something will “cure” what they have or they don’t need the meds.
And so, I learned that having a good diet will help some medications work better, but not all. Exercise just means you need to make sure you drink more water so you don’t get a lithium overdose. That therapy is nigh on useless (yeah, that was upsetting) because bipolar depression has to do with your prefrontal cortex being small. With salts and neurons not working together right. With circadian rhythms being off. Not hormonal imbalances and things happening in your life to make you depressed (like most unipolar depression, for which generally the things I’ve listed help.)
Here’s a comparison for you.
Regular depression = broken leg
Bipolar = missing leg
Broken legs are put in a cast (medication) to help support the leg as it heals. For some, the cast comes off after a period and the leg is healed. For some, they need physical therapy (… therapy) to strengthen the leg. Some few may need pins/metal put in the leg permanently or never be able to fix the leg entirely and so need crutches/wheelchair (permanent medication). They eat good food to help the leg heal. They exercise to keep it strong. Their leg can be healed permanently sometimes. They might get a broken leg again in the future of course, because you can’t always fix it forever. But often, there is some relief and some hope of never having it again.
Missing legs are gone. You cannot use physical therapy on a missing leg. You cannot exercise a missing leg. You cannot eat good food and grow back your missing leg. It will be gone forever. You have to find a prosthetic (medication) if you want to walk. You will try on several prosthetics. One might be too short. One might be too long. One might give you a rash. One might make you fall down every three months. One might fit just right, but it falls apart after a little while. You might have to put it on while laying on your back to make it fit. Once you find one that mostly works, after a while you might think, I don’t need this prosthetic! And then you fall down and break your other leg.
So anyway, that’s why bipolar is a different beast than depression. My doctor and a few of his assistants were talking to me about therapy, because I was like… wait, can’t I get therapy, just like with unipolar depression? Who’s a good therapist? And they all said, no. You can go to understand the disorder and to recognize when you’re having an episode, but that’s it. One of the assistants told me that in school, a psychiatrist came to talk to them and he was explaining that even as a psychiatrist you can talk to a bipolar all day long, run through exercises and stuff and it changes nothing. They’ll still basically go home feeling the way they did already and kill themselves.
I really really want to mention that telling someone with depression or bipolar disorder that they would feel better if they read their scriptures and say their prayers is a cruel cruel thing to do. It makes them feel like they’re just not good enough for God, and that’s not the case. And you do not “feel better”, by the way. My mom had a doctor tell her this once, and that was devastating (she was already doing those things). For me, the help came from a friend, not any sort of spiritual revelation while praying, and also, when I needed it most, a talk in General Conference about mental disorders that was exactly the right thing. And a Priesthood blessing, coupled with medication, pulled me into a good place. But it had to be direct, because it seems like that spiritual reception antenna is broken in the midst of these episodes. And not everyone will even have that sort of thing happen.
Currently I’m taking lithium (a mood stabilizer) with wellbutrin (an anti-depressant… ok, when taken with a mood stabilizer). Luckily, they seem to mostly be working. They might work for a long time. They might not. It’s really hard to say. They don’t permanently fix the problem even if they are working, because you can still go through depressive/manic cycle… it generally makes them milder and further apart.
One thing that sucks is considering having a baby when you have bipolar disorder. Going off your medication is a bad idea. The stress the bipolar cycling puts on the baby is not a good thing, along with uh, yeah, the chance of suicide. If you’re not on meds after you have the baby, you can have postpartum psychosis (people with psychosis are generally those mothers who end up killing their infants. Yes, they generally have a treatable disorder that no one noticed or was too scared to do anything about. Not to say everyone with psychosis does that… the lady on the news who thought President Obama was talking to her and rammed into the barrier probably had bipolar with psychosis, and she had a one year old.) You need to stay on meds. However, many of the medications can cause problems with a developing baby, so you have to switch to a safer one – which may or may not work as well. Being on an antidepressant while I’m pregnant scares me, as there is some evidence that it is linked with autism (which also appears in my family). And nursing while taking medication is a worry too, as is waking up with the baby every night, which can trigger manic episodes. Also, passing on bipolar disorder to your children is a worry, but I’m glad I was born, even if I do have bipolar disorder to work through. Every child you give birth to will have challenges of one sort or another and at least this one is treatable.
So anyway, be aware that mental illness can seem bizarre and scary and untouchable by you, but we need your support. Your love and help. We don’t know what’s going on either, and so a kind word and a helping hand can be such a comfort when everyone seems to draw away. And I hope this doesn’t scare you away from me. I’m much better now that I’m on meds, and I’m happy again. 🙂 So please be my friend, even though I’m crazy!