A simple tug at their bootstraps...
People use the term bipolar disorder somewhat flippantly. Oh, you know so-and-so, they are so bipolar. What- are you bipolar or something? When I was first introduced to world of mental health, bipolar disorder was known as manic depression. I didn't understand exactly what this meant, but saw very clearly that judgement was projected on people who had it. It appeared as though they were not only stigmatized, but blame was assigned to the person, so easily labeled as "crazy." Like it could all be fixed with a simple tug at their bootstraps. All better now. Not quite. While my personal interest in mental illness has driven me to this career, I never suspected that I would personally care so deeply for people that wake up every day without a promise tomorrow will look so bright. It changes things, to see true suffering at the hand of something entirely unseen.
After all, we are people- not spreadsheets...
Bipolar disorder is a bear to diagnose. Most of the time, the sufferer has been symptomatic for years before getting an accurate diagnosis from the appropriate source. Even more challenging to get stabilized. People don't often seek help when everything is going swimmingly. As I've addressed in my article for depression, mental health practitioners use a diagnostic guide called the DSM-V to see if someone meets criteria for a particular disorder or condition before making a clear diagnosis. The criteria for bipolar disorder is very difficult to assess with all that unique "humanness" surrounding an individual. After all, we are people- not spreadsheets. That being said, a person's head could explode reading through this muck. Let me break it down for you.
There are two types of bipolar disorder. Type I and II. With both, you have up's and downs.
Ups: Feeling elevated, hyper, dare I say joyful. Some people describe feeling like they are being run by a motor. They might exhibit rapid speech, feel creative, inspired, and need little to no sleep. This is called hypomania. We might all enjoy a hypomanic episode from time to time. People love milking this feeling in order to get things done! That's all well and good, but then there is a little thing called mania- it's like hypomania on crack. This is where the good goes very very bad. Mania may include risky behavior like indiscriminate sex, erratic overspending, rash decision making- like leaving a spouse, quitting a job, moving to another city at the drop of a hat etc... if this behavior continues to escalate, a person may even experience paranoia, psychosis, hallucinations (visual, tactile, auditory etc...), or delusions. A person may believe that the TV is talking to them, or they may feel so grandiose that nothing can touch them- they are god. Very scary stuff for the person in those shoes, and for the people that love them. Someone may even become a risk to their own safety. This story often ends in a hospitalization for stabilization. However, not all hypomanic episodes end in mania. Thank goodness.
Downs: What goes up must come down. This is extremely unpleasant. After all that sleeplessness and infinite possibility, comes the cement truck pouring heavy darkness all over them. Depression is a beast. I'm not a fan. Depression can suck the ever-loving life out of someone. Metaphorically and literally. It hurts. This is when people stay curled up in the dark on their bed or couch and they cannot function anywhere from days to months. Someone may be a rapid cycler and experience just a few days before finding even ground again- or they may lose their job from being a no-show for weeks. It all depends on the person, the episode, the season. This is a very unpredictable beast.
People often wonder what's the difference between bipolar I and II. Well, bipolar I means at least one manic episode with major depression. Bipolar II means major depression with at least one hypomanic episode. Bipolar I is a little scarier to me, because things have become escalated- at least once. This video describes it beautifully, if you're curious.
Strong warrior of a woman...
While I have known and loved many people in this life with bipolar disorder, perhaps the most influential survivor I’ve met is part of my own family. My daughter’s step-mom Leigh, has offered to share her vulnerable and courageous journey with bipolar disorder, that I may write to de-stigmatize all the chatter that’s passively exchanged about people with mental illness. It may be fear, or general ignorance from some, but one thing I know mental illness is not- funny. Settling in for our interview, Leigh and I sat in my home office, walls littered with my charcoal drawings, twinkle lights, and mismatched throw pillows. Both fueled with coffee mugs of caffeinated goodness, we braced ourselves for heavy stuff to flow. I sat in awe, honored that this strong warrior of a woman, would sit in her discomfort in order to educate people about her daily plight for stability, that she may raise her kids, love her husband, and create a little beauty in the world.
Heavy sigh. Where did it all begin? Leigh reflected back to her elementary school years, when she first started processing the world differently. Fifth grade. She described a picture on the wall of her classroom. A boy that had shot and killed himself in the seventh grade. As a ten year old, she remembered clearly thinking that suicide was a good option, and she might try it someday. While this appeared as logical thought in her young mind, this was a seedling that would later take roots and manifest. Fast forward to teen years.
Like a door opening her subconscious...
A turning point came when Leigh tried mushrooms for the first time. While this is a “natural” hallucinogen that is often viewed as a harmless drug for partiers in my own youth, she described this like a door opening her subconscious. Whatever was below the surface, erupted. She described a day, coming home from school and feeling overwhelmed with anxiety and depression. She was screaming and crying uncontrollably without any stimulus that would warrant this response. It was completely out of her control. This is valuable insight that she was not able to harness her emotions and regulate. While some may find ways to self-soothe with hobbies, exercise or social connections, these were not accessible to Leigh in this state.
A stressful life event turns that puppy on like a light switch...
In mental health, there is something called a diathesis stress model. A metaphor I like to use to describe this concept is based around health. If you have heart disease in your family- it’s possible that you are predisposed to be at risk for cardiac events. If you smoke, or engage in other risky health behaviors- you might have a greater chance of suffering a heart attack. With a diathesis stress model, this is similar. You may have a predisposition for mental illness because of inherited family traits, but this could lay dormant until a stressful life event turns that puppy on like a light switch. For some, teen years can be so stressful that mental illness may start manifesting at a young age. For others, it may be a trauma much later in life, even in their 30’s or 40’s. When Leigh was 21, her mother passed away from a rare autoimmune disease. In hearing about Roxy over the years, she wasn’t just a mother, but an unconditional support and love- that the world lost with her passing. A girl needs her mom. Especially this one. Leigh feels like this event started the ball rolling with her bipolar disorder. Ups and downs became standard, trending toward the “downs.”
She took the whole bottle...
During this period of darkness, Leigh didn't experience any insight or true awareness into her condition, simply tried to navigate life to the best of her ability until another event changed the game entirely. With the birth of her first child, she was unable to sleep, which led to symptoms of paranoia, delusion and psychosis. Leigh describes a time in which she was certain that people were stalking her. She began to hear and see things in the corner of the room, experiencing visual, auditory, and tactile hallucinations. In retrospect, she believes that her use of Ambien as a sleep aid, likely intensified her symptoms. At this time, her son's father asked to marry her, which led to a period of mania in which she planned an entire wedding in six weeks. While this sounds extremely productive and efficient, this can be a dangerous road to travel when prone to escalating moods. After returning from the honeymoon, she decided that she was "done" with life, and couldn't go on this way. As an illustration of her mental state at the time, she described a mole that was within periphery on her eyelid that became an unmanageable nuisance, so she cut the mole off with a knife. This was followed by a call to her counselor, a trip to the ER, and her first hospitalization. It was at this time, that she was officially diagnosed with bipolar disorder and alcoholism (even after lying about her drinking to minimize her problem.) While hospitalized, she was prescribed seroquel, a powerful antipsychotic used to treat bipolar disorder, major depression, and schizophrenia. Three days following her release, she took the whole bottle. Her new husband found her and got her to the ER to have her stomach pumped. Her desperate desire to be "normal" and fit into society's norms as perfect mother made her feel as if she didn't have a choice but to end her life.
Alcohol abuse became increasingly worse...
Though she started taking her medication semi-regularly, Leigh's alcohol abuse became increasingly worse over time, drinking after her husband and son went to bed. She reported consuming half of a large bottle of vodka every night, sometimes beer or wine in large quantities. It often depended on the type, or accessibility. Her marriage lasted for two years, before ending in divorce. Leigh verbalized gratitude for her in-laws, as they stepped in to "raise" her son during her high highs and low lows for about three years while she continued to spiral out of control on her own. During this time, Leigh's disease evolved into more frequent episodes of hypomania/mania and less frequent depression. During her single years, she described a time when her paranoia resulted in hiding kitchen knives all over her house, even behind pictures on the wall. Frightened a great deal of the time, she believed that others could read her mind- a common fear of people experiencing psychosis. She could hear full conversations between people talking through her vent system in her home. Later, there was another episode of psychosis she described in which she found herself awake at night drinking on her porch. She started to notice sounds of a party down the street, and thought she would join the crowd. She could see lights in the backyard, and the the noise getting consistently louder as she approached. Knocking on the fence, she asked if she could join the party. At that time, she realized it was pitch black, and no one was gathered there. Psychosis isn't just a laughable paranoia or confusion, but a reality for the person experiencing it. It could make you question everything.
These periods of extremes continued for years, through jobs, relationships, and ever-changing interests. Sobriety was something that was attempted periodically, but never seemed to stick. Years later- remarried, baby girl, son, and step-daughter, her disease continued its trek through her life. Perhaps it was the pressures of parenting, sustaining a new marriage, season changes, and worsening alcoholism, but Leigh's symptoms increased in severity. She began experiencing mixed episodes within her type I bipolar disorder. A mixed episode is a time in which moods alternate between elevated and depressed over time. A person experiencing a mixed episode will experience both mania and depression simultaneously, or in rapid succession. Whiplash. The changes are so sudden and unexpected, that it can appear as if someone is Dr. Jekyll and Mr. Hyde. Thoughts of suicide became more frequent. Her inner-voice echoed "you're a piece of shit" and "not enough" constantly. After sending a mass suicide text to her friends and family- she found her way to a bar and hunkered down for a good binge drinking session. Family frantic, the night ended in dislodging kitchen knives from her hands, intended for her own neck. Enter help.
Still raw for all that love her...
The interview took a turn at this point. Partially because this is where her story changes for the better, and we could both breathe knowing that she's safe and stable today. Perhaps because I was present for this chapter of her life, and it's still raw for all that love her. She reported the rest from a place of hope and gratitude. Residential treatment for alcoholism and bipolar disorder brought her back to life. Though Leigh has had the privilege of financial and emotional support from her family, not all are so blessed. For many, mental illness results in homelessness, incarceration, or suicide.
I am fortunate enough to come from a family that is able to financially help me. I went to treatment for 3 months at a facility that cost $60,000. I have gotten the best care in my community. I have a private doctor that does my meds, and I see her once a week, while still available on call 24/7. I can afford counseling, and have insurance because of my husband. It's fucked up that there are all these people dying because they can't afford help.
I couldn't agree more. For all her resources, she barely escaped her end with this story. Mental illness and addiction are equalizers. They see no class, race, education, religion....it's an equal opportunity destroyer. Today, Leigh has a year sober. Her full-time job is to care for herself and her family, putting her stability paramount to anything. She isn't alone. With an extended family, and 12-step family that love her without condition- she has the power to ask for help when she needs it.
Wrapping up, I asked her what the formula for survival was in her story- spanning decades. What she would tell other people with bipolar disorder- desperate for the other side of struggle. She offered the following:
Formula for survival...
- The biggest part is acceptance. Accepting that you are bipolar is huge.
- Honesty. Pure honesty with doctors and counselors. No bullshitting- or they can't help you.
- Meds. Take as prescribed and take notes. Write down symptoms and questions. Don't be afraid to ask to make changes if it's not working.
- Sleep is huge. Make sure you're getting 6-12 hours of sleep. It also depends on the person, but it has to be consistent.
- Eat healthy (not all sugar).
- Don't be too hard on yourself if you didn't exercise/eat healthy.
- Help others. Something as small as making sure she's there for her kids, or having a conversation with a homeless person on the street, or volunteering. Purpose is huge.
- Have to come to terms with not being 100% "stable" or "normal." Throughout the year, there are times of major anxiety, may be a little manic, hear some things that aren't there. It can be treated, but it will never go away.
- Keep things simple. Focus on priorities first.
- Has agreement with family/husband that they can call a "red flag," and she has to listen. Husband is involved in treatment, coming to appointments to offer observations.
- Support system!
- Be honest with kids. Give them power to make their own boundaries.
She's a force to be reckoned with...
Most people that know me, know that I'm a sensitive soul. Writing this blog has been both an honor and a struggle. I am in awe of this woman. Even now, I'm choking on my own emotions to spit out this last reflection. The first time I met Leigh, I was entirely unsure of this colorful spirit that stumbled on the role of step-mom to my daughter. The second she saw me from across the room, she was a force- honing in on me for an all-encompassing, and genuine hug. She was literally impossible to dislike. Her energy, patience, creativity, and honesty compel me to take down my own defenses and just sit in our mutual realness- talking for hours. This women, this Wonder Woman of sorts- has taken up arms and fought this bipolar monster for a lifetime. Tomorrow is never promised for anyone. So many of us take our quiet minds for granted. Leigh doesn't. It is a daily struggle to simply maintain. It's chronic and forever, but she's not denying it anymore. Not ignoring it, or checking out. She's in the game for herself and her family. While some people may feel burdened by the added dynamic of mental illness in their family, I choose to focus on the hidden blessings. The awareness, communication, teamwork, and resilience that has been demonstrated among every individual in Leigh's orbit- is humbling. She is unquestionably loved and cherished by many. Bipolar disorder is heavy. No question about it, but Leigh doesn't have to carry this weight alone. Any family that is touched by mental illness does better working together. Today, Leigh is stable. While this can change on a dime, the power comes from knowing the next steps if crisis hits. There is always a safety plan, and secrets are a thing of the past. I believe in her with the fiber of my being. I know some days try to swallow her with darkness, and others spin her out- but she's a force to be reckoned with. A force I am honored to call my family.