While it was not my original motivation, I continue to write this blog, primarily, as my contribution to the fight against mental health stigmas. I write to show that I am not ashamed of my illness, that there is no shame in having a mental illness, and that having a mental illness makes me no different from anyone else. I write because my story demonstrates that a person with a mental illness can accomplish many things, like graduating from both college and law school with honors, passing three bar exams in four years, being damn good at her job, and raising three young children. In short, I write this blog in hopes of convincing even one person that there is no “we” the mentally ill. We are you.
Given these motivations, my recent posts with cryptic references to a “new diagnosis” and “camp” have felt, at best, disingenuous and, at worst, hypocritical. I guess a small, scared part of me still worries that coming clean will change the way other people see me or feel about me; that I will be judged as less than or more fragile or already broken.
However, a bigger, braver part of me believes that anyone’s changed views or judgments based on the fact that I have an illness are absurd. If I were diagnosed with cancer or diabetes, no one would see me as different or personally flawed. The fact that my illness is mental and not physical in no way implicates my character, morality, or personal responsibility. That my illness is not easily measured or quantified, that it usually does not have physical manifestations, that it affects my mind and not my body does not make it any less real. I assure you it is very real and that I have no control over or responsibility for the fact of my illness. What I do have control over and responsibility for is how I choose to respond to it.
Most importantly, I choose to respond to my illness and the treatment I have sought for it without shame. I choose to be open and honest and real because that is the path consistent with my values and because for every one of us speaking out about our mental health there are hundreds, if not thousands, of people who remain silent. Silence keeps us from helping each other. It prevents us from educating others. Remaining silent ensures we will never overcome the outrageous and offensive notion that mental illness is more shameful and less valid than physical illness.
Because I am not ashamed and because silence is not acceptable, I offer you my truth:
For over a year after my twins were born, I struggled with significant and sometimes debilitating anxiety and depression. My doctors and I tried every combination of anxiety and depression medication we thought might help. I sought second opinions. I changed therapists. Nothing worked. If anything, my health and ability to function, at work and at home, continued to deteriorate. I began to believe I would never get better and I could not contemplate going on without some hope of recovery. After another, particularly severe, depressive episode, I decided I needed to try a more intense level of care. So, I took a leave of absence from work to enter an intensive outpatient treatment program (IOP).
IOP is generally designed to provide daily therapy and frequent med management so that a person may begin to recover and avoid inpatient treatment (i.e. hospitalization). Sometimes IOP is also used as a stepping stone between inpatient treatment and regular life. IOP provides the information and tools to help you start the journey towards wellness and to avoid or minimize relapse; it does not “cure” anyone – nothing does.
To enter my particular IOP program, I was required to participate in an intake evaluation, which included some administrative paperwork as well as an extensive interview and evaluation process with the program’s head doctor. For over two hours we discussed my medical history, my family’s medical history, my past postpartum struggles after my first child was born, my current postpartum struggles, and my inability to find an effective treatment for my depression and anxiety. When we had finished talking, the doctor told me that the reason I was not getting better was because I was being treated for the wrong illness and with the wrong medication. I do not have a depressive disorder or an anxiety disorder, postpartum or otherwise; I have bipolar disorder (II to be specific).
My reaction to this pronouncement was mixed. On the one hand, I felt almost giddy with relief and hope. Now I had a reason for why I wasn’t getting better and a new path that might actually provide relief. On the other hand, I felt more than a bit freaked out. Bipolar II disorder seemed much more serious and potentially dangerous to my health and my home life than unipolar depression or anxiety. My only personal experience with bipolar disorder comes from an ex-boyfriend with bipolar I, who has been hospitalized multiple times, and two female relatives who, I understand, have some type of bipolar illness that has seriously impacted their adult lives. Were these same things going to happen to me?
Having completed the IOP program and also done some reading on my own, I now understand that bipolar II disorder is serious but also manageable. It is a chronic illness, rather than situational, so I will always have it. However, I am unlikely to ever have a manic episode resulting in hospitalization, as occurs with bipolar I disorder. Instead, I will probably experience a few hypomanic episodes each year. My predominate symptom will be depression. The frequency and severity of both the depression and hypomania can be reduced by medication and proper self-care, but they cannot be eliminated. I will relapse on some level, again and again, for the rest of my life. Also, the risk of suicide for people with bipolar II disorder is fifty percent higher than the risk of suicide for people with unipolar depression. So there’s that.
In short, my illness is significant but not debilitating. So long as I take good care of myself, there is nothing to prevent me from living my life. My life, however, must change in certain fundamental ways for me to stay well.
Before entering IOP, I essentially worked two full-time jobs: one as an assistant attorney general and the other as the mother of three children under four and the manager of a household of six. I was responsible for my various case-related and general counsel work tasks, like writing briefs, attending meetings, providing client advice, etc. In my “off” hours I was responsible for all kid-related morning tasks, daycare drop-off and any illness-related early pick-up, all laundry, ensuring the kids had appropriately sized clothes and shoes for each season, grocery shopping, making dinner and cleaning up afterwards, caring for the twins on my own every Friday afternoon, ordering diapers, formula, baby food, etc, taking sick kids to the doctor, administering all medicine and other doctors’ orders, planning birthday parties, packing for family outings, and getting up, on average, two to four times a night to soothe, feed, change, etc. one or more of our three children seven nights a week.
Even if I didn’t have bipolar, this situation would not have been sustainable. In my case, the stress and lack of sleep, combined with postpartum hormonal changes, likely caused my latent hereditary tendency toward bipolar to emerge as a full blown illness. I was also prescribed an anti-depressant that causes rapid cycling in people with a bipolar disorder.
Now that I know what my illness is and how to minimize the likelihood and severity of relapse, I am choosing to live my life differently. So far I have not returned to work. I am spending my days taking care of myself and my family. This job has proven to be way more time-consuming and exhausting than my paying job, but it is also more rewarding. I feel more calm, I laugh more often, I am more present with my kids but also feel less guilty about taking time away to take care of myself.
At this point, everything still feels new and unsettled. Not working feels like I’ve lost a fundamental part of my identity. Being financially dependent on someone else feels strange and scary. My strong belief that being open about my illness is the right thing to do is not shared by some of my most important people. Building boundaries, asserting my needs as equally important, and standing my ground in the face of opposition feels foreign and selfish. And yet, I am doing all of these things and more because I want to feel better, not for the sake of my children or husband, but for myself. I deserve to feel better, to enjoy my life more, to do the things I want to do, and to make choices consistent with my values – not the values of others or that I have been told I should have.
Probably the most important thing I’ve learned from this whole experience is this: I am a person whose value and values are not contingent on anyone else; being a wife and a mother does not and should not alter my core self; and protecting my core self – by caring for it, listening to it, and loving it as unconditionally as I love my children – is fundamental to maintaining my mental health.
None of this is easy but it is not optional either. I cannot depend on anyone else to meet my needs or keep me safe, because I cannot control their behavior. I have to take care of myself. No matter what. End of story.