It’s been nearly seven months since I first walked into the behavioral health clinic and basically said, “I need help.” I wasn’t surprised to hear the words, bipolar disorder, that day (I knew. You can read my story from the beginning here), but I was surprised by much of what followed. Treatment has been both harder – so, so much harder – and more rewarding than I thought. I’ve found unexpected encouragement from some people in my life, and unexpected absence from others. I’ve found a lot of support and information… and even more misunderstanding and judgment.
Ever since that day, I’ve been devouring every related article, website, and social media account that I could get my hands on. The relief of knowing that someone else gets it, and the feeling of validation and comfort that comes with, “Oh my gosh, this is describing ME!” is immeasurable. At the same time, there is so much information out there, much of it repetitive and/or of dubious quality, that it’s hard to know where to begin if you’re a loved one wanting to understand.
Here then are ten of the top things I want people to know, and misconceptions I’d like to dispel. It’s by no means an exhaustive list, but merely a place to start.
1. It doesn’t look the way it looks in the movies.
A quick Google search will yield you a nice little list of a handful of movies with characters with bipolar (or characters with unnamed mental health issues that present a lot like bipolar.) I think I’ve watched them all. And while some are of course better and more accurate than others, in general they’re full of stereotypes, and/or appear as if someone was just going down a checklist of symptoms, trying to hit them all. Also, what movies tend to portray the most is unmanaged bipolar, not the day-in, day-out, un-sexy business of taking meds, going to therapy, and making a concerted effort to get enough sleep. Movies are meant to entertain and shock and awe, so it only stands that they’re going to emphasize the wildest and the craziest extremes. It’s important to remember though that the face of bipolar may also be the guy minding his own business next to you on the train. Your doctor. Your neighbor. Your mild-mannered mail man. It won’t sell movie tickets, but it’s also me… cross-legged on my couch in my furry pajama pants, drinking tea, and watching the Cardinals lose (again.)
2. It is different for every person.
Like any illness, mental or otherwise, bipolar is not one-size-fits-all, and can manifest itself in many different ways. Just because your brother is prone to violent and angry outbursts when manic, it doesn’t mean that that same symptom applies to every other person with bipolar. Yes, there are common symptoms used for diagnosis (more on that in later points), but the intricacies and variations are infinite. It is both unfair and inaccurate to presume to know exactly how bipolar presents for any one individual, unless you are intimately involved in the day-to-day life of said individual. Even then, so much of bipolar is intrinsically wrapped up in a person’s inner psyche, and not something you can see anyway. Don’t assume.
3. Depression doesn’t necessarily mean not leaving your bed all day.
Depression, the first half of a bipolar diagnosis, is often portrayed (again, think of the movies) as a person who is nearly catatonic. Unable to leave bed, unable to eat, unable to really do anything but exist in a haze of sleep and crying jags. And yes, absolutely, this version of depression is very real. But equally concerning, and equally real, is something called “functional depression.” I am intimately familiar with this form of depression, as it’s the type of depression in which I most often find myself. With functional depression, the person is able to go through the motions, albeit in a fashion that is greatly hindered. Depending on how brave of a face this person can muster, you may not even know anything is wrong. People who are functionally depressed may still go to work, take their kids to dance class, and show up at church every Sunday. Outwardly, they may be doing everything they need to do, while inwardly they are completely withdrawn, immobilized, disconnected, despondent. They might have lost all pleasure, and all interest, in life. Last spring, just before I’d bottomed out and finally decided to seek help, I was in the middle of taking my daughter to lengthy dress rehearsals several times a week for a theater production she was a part of. I was contemplating suicide, and no one had any idea. Even now, seven months later, seeing that sentence terrifies me.
4. Mania doesn’t necessarily mean wild flights of out-of-control fancy.
There’s a scene in the movie Mr Jones where Richard Gere’s character dances on a 2×4 (sans harness), high above the ground, in the midst of an manic episode. I think this is the sort of thing that people think of most often when they think of mania (the second major piece of a bipolar diagnosis): extreme, dangerous, and devil-may care. And it happens, to be sure. People experience euphoria. They may have hallucinations. They may become sexually promiscuous. They may engage in any number of risky behaviors. A lot of times someone’s manic episode will be the thing that lands them in the ER for the first time, leading to a proper diagnosis. But mania doesn’t always equal danger. It doesn’t have to mean amazing and exciting. It doesn’t have to mean wild and out of control. For me (and for a lot of people) it’s somewhere in between all of the above. It’s staying up all night to write, or create, or plan, because sleep suddenly isn’t really needed. It’s feeling like you can be anything, or do anything, or experience anything. It’s feeling that the world is at your fingertips. It’s bursting with great ideas and big plans, and spending lots – and lots – of money to make them happen. It’s talking too fast, because you’re just too excited, and your mouth won’t keep up. It’s motivation; motivation to do more projects than most people do in a decade. It’s a whirling and swirling and unending rush of adrenaline. It’s crying every time you go for a walk because the trees and the sky and the cracks in the sidewalk are just so. damn. beautiful. So is it a good feeling then, some might ask? I’ll be honest: it does sometimes feel like a positive in that it does bring euphoria. It does bring such a rush of ideas. It does bring so much creative energy. The problem is that along with that creative energy comes restlessness, and racing thoughts, and a feeling of wanting to crawl out of your own skin. And through it all, no matter how good it may feel in the moment, it’s all happening with the knowledge that the crash is coming. Like a tidal wave it’s coming, and there’s nothing you can do to stop it.
5. It’s not just about depression and mania.
Depression and mania of course get the most air time, but the symptoms don’t end there. There are actually a lot of different symptoms, many often occurring at the same time. There is something called a “mixed episode”, which as the name implies means that elation and depression are present at the same time. There’s the propensity for addiction. All or nothing thinking. Irritability. Impulsiveness. Sleep disturbances. Memory issues. Racing thoughts. Agitation. Sexual symptoms. Anxiety (this is currently the most debilitating piece for me, particularly in the “bridge” phase between depression and mania). There is lack of – or too much – energy. There’s fatigue, both mental and physical. There’s physical pain. Symptoms can last for weeks or months at a time, or they can be rapid cycling, meaning that you’re never quite sure what may be coming when.
6. It is more than just “ups and downs.”
“We all have ups and downs. Why would you feel the need to label it as bipolar?” Well first, I didn’t label it bipolar, medical professionals labeled it bipolar. Second, yes, absolutely… we all have ups and downs. When I’m doing really really well, I have ups and downs. Bipolar is a very different thing than “ups and downs” though. It is completely, 100% normal to have ups and downs. It is NOT normal to have “downs” so low that you no longer see the point in living, and to have “ups” so high that you no longer feel the need to sleep, or to make prudent decisions. When I first heard this comment, several months ago, I felt frustrated and insulted. Today I recognize that it just comes from genuine ignorance, and I feel happy (really) for this woman who does not have to experience the actual and extreme “ups and downs” that bipolar brings.
7. In order to be managed, it first requires treatment.
Bipolar treatment may include any combination of: medication, natural therapies, lifestyle changes, psychotherapy, etc. I carry no shame in saying that my treatment currently includes medication (a cocktail of three different meds at the time of this writing), though many people certainly try to shame me. Some comments are overt, and others are more subtle about it, but the judgment is still there. I won’t defend or excuse my own choices, but I will simply say that for me, I have absolutely zero doubts about the path that I’m on. I tried all the supplements, the herbs, the oils, changing my diet, getting enough exercise… and for me, it wasn’t enough. Taking the right medications at the right time quite literally saved my life. As did therapy – which I fought tooth and freaking nail at the beginning, but that ended up becoming one of the most important things I’ve ever done. Without appropriate treatment – no matter what that treatment ends up looking like – people tend to either self-medicate (with things like alcohol, drugs, compulsive behaviors) OR they continue to cycle through the elation and the depression, going through lengthy periods of dysfunction. I have done both, and I recommend neither. Bipolar doesn’t go away on its own. It doesn’t go away by force of sheer will power. It doesn’t go away by talking about it with a friend, no matter how understanding that friend might be. One of the most insensitive things someone said to me in the early days of diagnosis came in response to my confiding in her that I’d had to admit to the psych doctor that I’d been suicidal. “But didn’t the feeling go away once you said it out loud?”, she asked me. It doesn’t really work like that. Saying things out loud was what served as my impetus for getting help, but it for sure didn’t help in and of itself. Admitting you need help is hard. Doing the actual work needed to help yourself is even harder. If your friend/family member/loved one is seeking professional help, support them. Support them like crazy.
8. Managing bipolar is a full-time job.
There’s no “cure” for bipolar. It can be managed, but it doesn’t go away. Dealing with bipolar is a lifelong, 24 hours-a-day job. There are good days and bad days, good weeks and bad weeks. At the time of this writing, I’ve been in a dip for the past couple of weeks, and am trying to give myself lots of gentleness and grace as I work my way through it. Medication helps. Therapy helps. But they’re just the beginning. The day-to-day management, the will-I or won’t-I make the commitment to stay as well as possible is all on me. And it’s hard. And it’s tiring. And it would be SO EASY to let myself slide back into the safety of the darkness of depression, or into the numbness of a strong Captain and Coke (or five). I know I can’t skimp on sleep. I know I need to regularly take my meds and my supplements. I know I can’t skip appointments. I know I need to keep up with exercise and eating right and doing all the effing hard inner work that I complain to my therapist about every week. And
sometimes a lot of the time, it pisses me off that it’s all so much work right now, but I do it. Because I owe it to my kids. I owe it to my husband. I owe it to MYSELF.
9. You don’t understand it… unless you do.
I think a lot of the time we so badly want to be supportive that we say things with the best of intentions that just aren’t truthful. Or helpful. Or kind. At the top of this list is “I understand.” Please, please don’t say this if you don’t in fact have personal experience. Having a bad fight with your husband or going through a funk because you can’t lose those last 10 pounds sucks, and I’m really sorry you’re experiencing that. Truly. But it’s not the same thing as living with a mental illness. It’s just not. Like so many other things, you can’t understand it unless you live it. I’m living it myself, and I’m still figuring it all out. Being supportive doesn’t need to (and shouldn’t) include words like, “I know how you feel.” To this day, the best thing anyone’s said to me about it all was this: “That sounds really hard. I’ll be thinking of you and sending you love while you work through this.”
10. It doesn’t define who a person is.
It always makes me cringe a little every time I hear the word bipolar used as a major descriptor. Especially since it’s so often used in a negative way. Ie: “My bipolar brother just went to jail again.” “My stepfather is such a jerk. He’s bipolar.” People with bipolar can go to jail, sure. And yup, they can also be jerks. But so can anyone else. Having bipolar doesn’t need to be a negative, nor does it excuse negative behavior. It is one piece of a very big, very complicated, very intricate whole. I’m not a “bipolar person.” I’m still ME. I’m creative and dorky and love my pets more than I love most people. I like coffee and movies and office supplies. I love the smell of the desert when it rains, and laughing till I cry around the dinner table, and getting new tattoos. I get excited when there’s a new episode of my favorite TV show. I’m me. I’m you. I’m all of us. A unique, imperfect, multi-faceted human. Not a diagnosis.
Bipolar (and mental illness in general) still very much comes with a stigma, largely due to misunderstanding and/or fear. It’s why I continue to talk about it, and write about it, despite the people who tell me not to, or are uncomfortable with hearing about it. I’m here to ask you to get comfortable with your discomfort. It’s not just that I think it’s okay to talk about it… I think that we need to talk about it. So many people are afraid to mention it, afraid to ask questions. But I’ll tell you what: when I know that you know, and the topic is deliberately avoided? It is so much more awkward than even the most awkward of questions. It’s an illness, not an elephant.
I have learned so much in the past seven months. So, so much. Bipolar has forced me to learn, and to grow, and to do all those hard and adult things that productive people are supposed to do. Calling it a blessing doesn’t seem quite right, but there is a greater good to be found, and I think that’s okay.
But some days? Some days it just really, really sucks. And I think that’s okay too.