Accepting a mental health diagnosis

Back in my public defender days, I worked for a time in various psychiatric units representing people being involuntarily committed for treatment.  As I listened to clients describe their delusions, I often thought, “How can you not realize that this is CRAZY?!”  The government implanted tiny listening devices in your ears to spy on you?  REALLY?!  The entire experience left me with one overriding impression: this shit was real.  Sit alone in a room with someone talking to their imaginary friend and you’ll believe in mental illness, too.

Despite the obviousness of their symptoms to everyone else, denial was common.  This is understandable.  After all, what reality do we know other than the one we experience?  How would you feel if you were Neo and Morpheus tried to tell you about The Matrix?  This is probably what it feels like to be told that your delusions aren’t real.

I quickly learned that the most common problem with bipolar disorder is NOT that there aren’t effective treatments, because there are.  The most common problem is that people refuse to believe they are bipolar and refuse treatment.  After all, why take medication if there’s nothing wrong with you?

In my opinion, bipolar disorder uniquely lends itself to denial.  Here’s the thing about bipolar disorder:  you’re normal, and then you’re not.  A bipolar person can go long stretches of time with a normal mood, and alternative explanations can always be found for the not-normal moods.  Typically, it takes six years for a person to be correctly diagnosed with bipolar disorder.  (Footnote 1.)

Despite my education and experience, I still struggled to wrap my brain around my diagnosis of Bipolar 2.  People are complicated, which makes mental illness complicated.  While it was so easy to see my clients’ mental illnesses, seeing it in myself blew my mind.  I was probably hypomanic in college, but college is a crazy time for a lot of people.  I became severely depressed after the birth of my first child, but many new moms gets depressed.  When I became very hypomanic, my basement had just flooded with sewage and I had two little kids.  Who wouldn’t be stressed out?

The line between mental illness and personality, character, choices, life events, etc. can be very fuzzy, but there is still a line. I’m a social person and I love people and parties.  This is my personality.  Sometimes hypomania can make people very social.  Hypomania isn’t a personality type, though, hypomania is a medical condition.  Can you see how it gets confusing to distinguish between the two?  It helps that I’ve met many types of people with bipolar disorder.  We are all different, but our symptoms are the same.  This helps me see my condition as a condition, not as my personality or my character.

Ultimately, acceptance is a choice and I choose to accept my diagnosis of Bipolar 2.  I go lawyer on myself about it.  I say, “Two separate psychiatrists diagnosed me with this condition.  My dad was bipolar, and there is a strong genetic component involved.  I’ve experienced both depression and hypomania, which is all that is required for a diagnosis.  The evidence that I have bipolar disorder is compelling.  Therefore, I choose to accept this diagnosis.”  Once a lawyer, always a lawyer.

While acceptance is very humbling and forces a re-orienting of one’s reality, it’s also very liberating.  Finally, I don’t feel alone in trying to untangle the knots in my brain.  Finally, I have a name for why I always felt so different.  Finally, I am getting the proper treatment.  Finally, I am taking proper care of myself.  As a result, I feel so much better now!   I’m more at peace and content than I’ve been in years.

I didn’t choose to have bipolar disorder, but I do choose to accept the diagnosis, and doing so is turning out to be one of the most empowering, enlightening experiences of my life.  There’s something very liberating about facing your worst possible fear and living through it.  We don’t choose our struggles, but we do choose how to respond, and who knows-  you may even come out stronger on the other side.

Footnote 1.  https://psychcentral.com/news/2016/07/26/nearly-6-year-delay-found-between-onset-diagnosis-of-bipolar-disorder/107687.html

Diagnosis

In December of 2014, I sat in my psychiatrist’s office as she asked me questions like, “Does it feel like your thoughts are racing?”, “Do you have a hard time focusing?” and “Are you sleeping?”   Were my thoughts racing?  OF COURSE THEY WERE!  Doesn’t everybody’s?  Did I have a hard time focusing on one task at a time?  Obviously!  I am a very busy person!  Was I sleeping?  I slept until 4 am every day, when I spontaneously woke up and starting thinking about my to-do list.  In addition, my senses were heightened.  Colors were brighter, sounds were louder and smells were stronger.  It felt like my brain was on fire.

My doctor’s next words were, “This concerns me.  I think we might be dealing with bipolar disorder”.  I burst into tears.  (Side note:  It’s never good news when your psychiatrist says, “This concerns me.”)  She clarified that she thought I had Bipolar Disorder Type Two, a diagnosis later confirmed by my current psychiatrist.    Bipolar Disorder Two is characterized by periods of depressed mood alternating with periods of hypomania (less than full mania), often with long periods of normal mood in between.  (Footnote 1.)

I’ve always experienced periods of intense productivity and energy, when I feel connected to the universe, can work tirelessly, am excited about life and feel full of hope, creativity and plans for the future.  I’ve also experienced periods of real depression, instability and extreme agitation.

My life story was unusual, though, so it seemed natural that my moods would be extreme.  I was born into an established, upper middle class family in Tulsa, Oklahoma.  We enjoyed a beautiful home, a country club membership, nice cars, trips to Vail and the Bahamas and an extended network of family all within a few miles.  We were happy.  Through bad luck, a downturn in the economy, and most likely an undiagnosed mood disorder on my dad’s part, though, my dad lost his business and we lost everything.  When I was eight, we sold our possessions and moved to California with nothing: no money, no family and no connections.

The next several years were a struggle and weren’t happy ones for my family.  My mom kept a roof over our heads with her teaching job, and my sister and I worked hard to get scholarships to college.  I loved school and was highly motivated to succeed.  Some caring adults took my under their wing, and I got lucky.  I got into Stanford and received enough financial aid to attend.

As a result of these circumstances, I viewed my life in terms of survival.  I was born into wealth, a large extended family, and a happy life.  Then we lost everything and it all fell apart.  My family fell apart.  Through hard work and determination, though, I had fought my way back to the top.  My life had been bipolar.  Who wouldn’t have had some extreme moods in these circumstances?  I had fucking made it.    

By the time I sat in my psychiatrist’s office at age 35, though, I suspected that I was different, and not just in terms of life circumstances.  My life was very stable by that point, but my moods were not.  I was happily married, we were financially stable, I had great family and friends, and my life was generally pretty great.  Despite this stability of circumstances, though, I still had “on” days and “off” days.  During the “on” days I could care for my kids, eat healthy food, exercise, do errands, engage with others socially, get all sorts of things done, and felt excited about life.  On the “off” days, though, I felt no joy about anything and just wanted to sleep.  I wasn’t able to care for my kids without hiring help, and this caused me endless shame.  I couldn’t reconcile my “on” self with my “off” self.  How was it that I had run a fucking marathon, but couldn’t function?

It was obvious to my psychiatrist on that fateful day in 2014 that I was in the middle of a full-blown hypomanic episode, triggered by being on an antidepressant.  This is a very common fact pattern:  person with latent bipolar disorder gets depressed, seeks help, is incorrectly diagnosed with simple depression, is put on an antidepressant, gets hypomanic (or manic) as a result of the antidepressant, and is correctly diagnosed with bipolar disorder.  (Footnote 2.)

I knew my brain felt out of control, and started to wrap my mind around the idea that it had a label.  For the first time, I considered the possibility that my extreme moods weren’t normal.  My doctor immediately started weaning me off the antidepressant, and started the process of putting me on the correct medication.  Recovery began and it was official.  I was bipolar.

Footnote 1.  www.webmd.com/bipolar-disorder/guide/bipolar-2-disorder#1

Footnote 2.  www.psychiatrictimes.com/bipolar-disorder/switching-mood-depression-mania-antidepressants