Would I choose?

I recently re-read An Unquiet Mind by Kay Redfield Jamison. Dr. Jamison is notable for, among other reasons, having written the best-selling memoir on living with bipolar disorder and co-authoring the definitive textbook on the same illness.

I read An Unquiet Mind for the first time nearly 20 years ago, in hopes that it might help me help a newly diagnosed friend. It did not, for a number of reasons mostly unrelated to the book. My second reading was far more personal, meaningful, and difficult. Having been diagnosed just a year ago, and having spent most of the past year struggling for stability, I have not had the ability or desire to think about whether and how this illness may have impacted my life for a greater period of time than the past two years. Dr. Jamison’s account of her decades-long, often tortuous dance with mania, hypomania, and depression made clear to me that my own illness existed long before its diagnosis. In my unscientific, but very fact-based, opinion, my bipolar disorder first emerged when I was 18 years old and a freshman in college.

My episodes of depression started just a bit before college and have carried forward to today. Those episodes I have always been aware of. Now, from a more medically-stable, knowledgable perspective, I can also see the episodes of hypomania, glittering like stars in a constellation that stretches from 18-year-old me to 38-year-old me. I am tethered to my much younger self by this illness, which I didn’t even know I had until last year.

Reflecting on both my depressive and hypomanic episodes — during college, during graduate school, after my first child was born, after my second and third child were born — is enlightening and heartbreaking.

Particularly for my college, graduate school, and early work experiences, I have no doubt that much of my creativity, endless amounts of energy, and near-perfect work product was the result of hypomania. It was also the result of me. It was hypomanic me. Alison on chemically-imbalanced speed. I was and am a very good student. I was and am a very good attorney. But I believe I was and am those things, in part, because of my illness.

My hypomania has also played a significant role in my personal relationships. I have been very good at falling in love, with friends and lovers. Over and over, I have jumped without looking, expecting to be caught. And I have been given such love that my heart would burst. And I have been let down so low that I wanted to die. But I have loved hard and true and again. Some people I have loved with my whole self and yet hurt them callously. I have been reckless. I have done things that were terribly wrong. I have lied. I have betrayed. I have become very, very lost from the person I believe I am, or wish to be. In short, and thanks, in part, to my illness, I have brought to my relationships the biggest heart and, sometimes, the sharpest knife.

Motherhood, which likely exacerbated my bipolar symptoms, has likewise been a devastatingly beautiful and overwhelming fearful experience. I have never loved so much, laughed so hard, or been so heart-burstingly proud. I am in awe of my children’s kindness, character, and resiliency. They are each unbelievably funny and extremely thoughtful in their own unique way. Of course, they are also three huge pains in my butt, but mostly in an age-appropriate way. What has made motherhood difficult for me is not my children but me and, most likely, my mental illness.

Bipolar disorder had taken what I assume are some of the normal insecurities of motherhood and magnified them. As a mother, I have never been so convinced of my inability to know and do the right thing; whether they are sad, shy, rude, angry, hurtful, careless, sick, or just plain annoying. Given my fear and hesitancy, among other things, I feel I am fucking up my children every single day, and have felt that way for almost five years now, although adding the twins to the toddler was particularly difficult. With one child, I could carry all my crazy around, keep him alive, and still otherwise function like a mostly normal person. After the twins arrived, I didn’t have a snowball’s chance in hell.

As detailed in prior posts, the two years since my twins were born have been the most difficult of my life in terms of mental and emotional stability. Basically, there has been no stability until just recently. Instead, I had horribly irritable, anxious hypomanic periods that built and built and built until I hadn’t slept and could’t stop talking or thinking or trying to do ALL THE THINGS. Then my head and heart would explode in the form of a massive panic attack, typically in my parked car just before work on a Monday. I would then spend the next three to five days in a coma of depression, not able to leave my bed even to make my small son lunch or my even smaller children bottles. I would sleep and cry and sleep some more, until eventually I felt more or less human, at which point I would head right back to work and mothering and household management until it all became a frenetic explosion in waiting, again. Thankfully, I finally realized I would not survive many more trips around the crazy merry-go-round and let go. I quit work, went to treatment, and started, slowly, to get better.

Flash forward other year and here we are. In just the past few weeks, I have stopped experiencing a near constant mixed-state of hypomania and depression that made me furious with everyone all the time and also want to kill myself for being such an awful mother, partner, and human. For the first time in two years, I am feeling mostly okay. My marriage is intact. My kids seem fine. And I am starting to feel safe enough (most days) to think about where I have been and what impact bipolar disorder has had on my life.

In the epilogue of her memoir, Dr. Jamison poses the question whether, given the choice, she would choose to have manic-depressive illness. (Dr. Jamison prefers the original name to the subsequent and supposedly less stigmatizing term bipolar disorder). Her answer (with the assumption that lithium is available to her as an effective treatment) is yes.

My reaction when I first read this statement was to immediately distinguish her situation from my own because she had, as described in the book, repeated, euphoric manic episodes during which she traveled the cosmos and heard the singing of the spheres (I’m paraphrasing, of course, but she did pass by Saturn). She must feel that those moments of ecstasy made it all worth it, I thought. I was wrong. Instead, she writes:

I honestly believe that as a result of it [manic-depressive illness] I have felt more things, more deeply; had more experiences, more intensely; loved more, and been loved more; laughed more often for having cried more often; appreciated more the springs, for all the winters; worn death “as close as dungarees,” appreciated it–and life–more; seen the finest and the most terrible in people, and slowly learned the values of caring, loyalty, and seeing things through. . . . Depressed, I have crawled on my hands and knees in order to get across a room and have done it for month after month. But, normal or manic, I have run faster, thought faster, and loved faster than most I know.

This was not what I was expecting; it hits much closer to home. Not all, but much of what Dr. Jamison describes as being the result of her illness are feelings and experiences I have had over the course of my adult life: the intensity of life and love, the arms-wide-open lunge towards  light and funny and new, and the implicit knowledge that compassion, loyalty and determination will always get me home. I have literally and actually crawled on my knees across rooms of my life. I have literally and actually run fast, thought fast and loved fast, faster than was wise, perhaps, but as fast as I needed to go.

So, with the same assumptions about lithium in place, were I given a choice, would I choose to have bipolar disorder?

No.

For all the added emotional depth it may have brought to my life and any added mental acuity, bipolar disorder has made my life as a wife and mother indescribably painful much of the time. In the worst throes of a hypomanic or depressive episode, I have done unspeakable things, risking not only my own health and happiness but that of the people of I love most in the world. I have done terrible things but, more significantly, I have done nothing; I have absented myself from the lives of my husband and children, no matter how much they needed me. I just could not be there for them. I think I will always struggle to accept that this happened and that it is okay.

The other struggle I will continue to face is my near-constant, immutable belief that I am continuing to fail everyone in some terrible, unforgivable way. I recognize there are times when I have actually done something horrific, but I am often unable to distinguish between those times and every other time I fail to meet my husband or child’s need or want. I am so accustomed to being the person in the wrong, who forgot something, or lost it, or took it when it wasn’t hers; who didn’t show up, or canceled at the last minute, or had to go to bed because she was just too tired to be alive. Having bipolar disorder, especially at the exacerbated level that I had it over the past two years, has altered my relationship with my family and myself. I don’t trust my instincts, value my intuitions, or make firm choices. I feel so horribly indebted to everyone for the hurt I have caused, I assume I will never be able to pay them back but keep trying anyway, of course.

When I was actively sick, the only thing I could focus on was just that: I was sick; I was going to get better. Day in and day out this was my one, cogent thought. Now, I can see so much more of what is and has been going on around me. And I am devastated. I am actively working on being less devastated. I know that my mind and my moods are exaggerating the negative impact that I have on my loved ones. But knowing and feeling are two very, very different things, especially when one suffers from a mood disorder.

So, no, Dr. Jamison, I would not choose to have bipolar disorder, even if I did get to visit Saturn once or twice. Thanks in large part to your book I now see my illness has some value. It has brought me some extraordinarily beautiful gifts at various points in my life. But what matters to me most is my life as it is now together with my family. And we both know that no matter how stable I may become, this business of being bipolar is not over. It will never be over for me, or for my loved ones, whether it be my illness, that of one of my children, or one of my grandchildren. We will all always be waiting for the other shoe to drop. That is not the way I would choose for us to live.

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