Next Question

I started writing this blog in the fall of 2015. Over the past two years, I have used it to ask and answer questions about my life, some vital, some less so. In large part, writing a post is, for me, a means of spitballing with the world, and myself, about whatever question is making the most noise in my head at the time. Today that question is this: What’s next?

Now that I have been stablish on my medication for about a month, what is the next step, the next thing to be done, the next goal to achieve before moving on to the one after that until I finally reach the place where it all feels like normal to me again?

I had recently spent a great deal of time trying to figure this out for myself before remembering I have paid experts who can tell me these things. So, I asked my therapist. Specifically, because it is football season and I am a dork, I asked her if there is a goal post now and, if so, where is it? Unfortunately, her answer was basically to punt (ha!) and say that, at this point, what well and good looks like to me is for me to decide and then work towards. I considered objecting as non-responsive but thought better of it because (a) not a lawyer anymore and (b) she’s most likely giving me the most responsive answer there is. I just don’t like it.

For more than a year now, I have had a relatively detailed map to follow away from sickness and towards wellness. I went to treatment. I changed medications. I resigned from my job. I went to therapy. I changed therapists. I changed doctors. I changed medications, again. I lived many, many weeks focused on making it from my bed in the morning back to my bed at night without doing or saying anything harmful to myself or others. It may have looked like I was just puttering around the house and hanging out with my family but, believe me, I was fighting for my life some of those days. A lot of those days. That’s the thing, or one of the many things, that’s hard about mental illness, right? Other people can’t see it. They can’t see the pain or anger or fear or sadness. They can’t feel those things either. They can’t feel what it is like to fight back against those things using the same weapon that is trying to kill you: your mind. It is a fucked-up thing to be fighting with your own mind, not to mention your heart and your soul. It hurts so much you want to die. And some of us do.

I didn’t die, obviously. And now I’m not on the front lines everyday battling for my sanity. So, what do I do now? Obviously, maintaining my mental health requires a myriad of tasks, daily and weekly, but does not fill up every minute of my day. Those extra minutes are currently filled with kid stuff and house stuff. I’m also trying to write more, more on this blog but mostly for other platforms like mental health websites. I’m also in the very early stages of maybe sort of pitching a book but I’m not fully committed and so mostly it doesn’t get worked on. And, really, that’s my problem, or my question. Does well and good look to me like a mom who writes from home in between drop-off and pick-up? Or a full-time attorney who is also a mom and a wife and a human in her spare time? Or a part-time attorney trying not to work full-time hours? Or something else entirely?

Does it look like a person with the ridiculous good fortune to workout (mostly outdoors) five to seven days a week? And who gets to go to hour-long therapy sessions weekly? And doesn’t have to worry about when to squeeze in her med checks or her (three!) children’s doctor and dentist appointments?

What do I want to be when I grow up? That seems to be the question I’m asking, which feels a bit childish, but also appropriate. I did grow up to be a full-time attorney, mother, wife, and individual. Then, due to genetics and circumstances, that life, my life, fell apart, it disappeared, and now it’s gone. So the question is do I want to re-build it, or do I want to build something else? Of course, this is all assuming I have the financial ability and buy-in from my partner to do something else which I am hopeful I do; also there’s the practicality of having the expenses but also the time and emotional resources required to care for three kids who are not even in school yet.

The more I think about it the more my doctor’s question seems to be an appropriate one for deciding what I want to do next: what does well and good look like to me?

Well and good, to me, looks like a whole day of feeling like a pretty good mom who wasn’t too stuck in her own head to notice what the little heads around her were up to, who didn’t yell or cry (much) because of stress or symptoms of her illness, who said yes as much as she reasonably could, and laughed.

Well and good looks like waking up without a sense of dread or panic because of ALL THE THINGS that need to be done within the span of that single day. I spent years waking up like this and whether it was a symptom of my illness or a cause I don’t miss it and I don’t want it back. I want to wake up feeling ready to do what needs to be done but not overwhelmed by it. I also want to have space in my days that make me curious, time that I’m not sure how I will spend but will (most likely) get to spend the way I want to, or the way I need to because of some unforeseen emergency that would normally throw my whole, tightly-knit plan the day into a tailspin of anxiety.

Well and good looks, to me, like being a wife who is more often happy then angry with her husband because of who did or did not do what needed to be done. It also looks like having the time and emotional resources to be the one who does all the things because her husband simply can’t due to work commitments (and vice versa). It looks like having the time and inclination to be something other than co-parents and financial partners.

To me, well and good is purpose and meaning consistent with my mental wellness but not too cautious to be truly challenging and even a bit scary. Well and good is, in large part, taking care of family. But well and good is not a life of regularly scheduled, relatively manageable tasks with a few surprise challenges sprinkled in. Purpose and meaning come from being a mother and wife but also from being myself, from doing something, or many things, that give me pleasure and a sense of accomplishment.

Now, I just need to figure out what that something, or many things, are. Next question.

 

 

 

 

 

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.

One Week

It has been one week since I stopped taking the last med prescribed by my former psychiatrist that is counter-indicated for my illness. While my episodes of hypomania and depression became severe and rapid-cycling in 2015, I am on day seven of being both properly diagnosed with bipolar disorder 2 and properly medicated. I feel hopeful and devastated, thankful and furious.

While I still feel somewhat fragile, my mood seems to be settling down somewhere near where it used to live. I am still prone to emotional outbursts, both sad and angry, but those outbursts occur less and less often. The other day I put on make up for no particular reason, something I have not done in close to a year. I have laughed until I couldn’t breathe at something my husband said and at something one of my children has done. I make jokes. I can’t remember the last time I laughed, or expressed any happy emotion, spontaneously and without it feeling at least a little bit forced. I am reading books that are not for my children and are not about bipolar disorder. I listen to music and sometimes I even dance a bit around the kitchen. My husband and I are going to a concert in two weeks, our first since L and C were born. I think about going back to work, not in the near term but as an actual possibility to be considered. All of these things give me hope. These things also devastate me.

I am devastated by the days and months and years I have lost; by the moments I missed because I was to anxious or angry or depressed to be present. I am devastated that I don’t remember a great deal of L and C’s first two years, not in a “two newborns and a toddler whirlwind” sort of way but in a “I have no memory of significant spans of time during which I was ill but not properly treated” sort of way. I have wept over baby book entries I could not complete. And H, I am devastated that he is old enough, has been old enough all along, to remember what these years have been like. I am crushed by having been truly mean to him, by having frightened him with my instability, by having pushed him to his father when he came to me because I just could not do it. I am also devastated by the toll my illness and my ongoing recovery have taken on my marriage and my husband. I have suffered and he has had to watch. He has tried to help and I have rejected his offers, angrily insisting he read my mind and provide me with something else entirely. Writing about these emotions and events wrenches my heart and makes it difficult to breathe. But this is what happened. I can’t change it. My only and best option is self-compassion.

Thankfully, self-compassion is one of the many new skills acquired during my intensive outpatient treatment and therapy since leaving treatment. Also helpful are self-differentiation, boundaries and value-based living. But self-compassion, loving myself regardless of what I do or fail to do each day, whether as a mother, wife, patient or human, is by far one of the most important (and most difficult) lessons I have ever learned. Honestly, it’s still a work in progress, but I’m getting better, and I love myself even if I’m not. I am thankful for the many healthcare providers who did their best to keep me safe along the way, even if they didn’t get it exactly right. I am particularly thankful for my last therapist, who steered me finally in the right direction. Thanks to her, I now have both a psychologist and a psychiatrist eminently qualified to treat bipolar disorder 2. Thanks to her, and to my new psychiatrist, I have been taking the proper medication for my condition for seven days.

However, the fact that it took just under two years for me to get to this place of near stability is infuriating. How many fucking PhDs and M.D.s does it take to properly diagnosis and medicate a single person? More than it should, my friends, more than it should. I spent over a year being treated for “treatment resistant postpartum depression” which I did not have. I spent nearly two years being prescribed medications that made my actual illness significantly worse. My panic attacks and, likely, many of my hypomanic and depressive episodes were triggered, at least in part, because of my medication. Because I did what my doctors told me to do, I got sicker. And sicker. So sick that I came much closer to the edge than I would like to admit, particularly as a mother. Bless whatever small part of me was able to pull back and run the other way in search of help. Of course, the help properly diagnosed me but failed to properly medicated me and sent me back to the same doctor who screwed up to begin with. But, I could have said no. I could have asked more questions. I could have said this doesn’t seem right; I don’t feel like I’m getting better. But I did not do those things. I just kept going, trusting that, eventually, the motions would get me home. And so they have, at least they’ve gotten me damn close.

I have felt better before. There have been days in a row when it seemed everything was finally, mostly okay again. But it wasn’t. I am hopeful this is not one of those times.  Given the hellish medication changes I have gone through to get here, I think this time will be different. We may need to tweak things but, fingers-crossed, the worst is over. Of course, I still have much to learn about managing my symptoms and avoiding or minimize future episodes. And I still have to mother three toddlers and be a wife and figure out what to do about work and about a million other things. But for now, I am just going to be here in this unfamiliar place of near normalcy. It’s been a long time coming.

What is true?

As a person with mental illness, I struggle daily to distinguish between what thoughts, emotions and actions are truly mine versus symptoms of my illness or side-effects of my medications. Did I just raise my voice to my son because I believe he did something significantly wrong? Or, did I do it because I’m hypomanic and, therefore, super irritable? Or because I am tapering a medication, which has significantly increased my anxiety? Which one is it? Or, is it all of the above? Some? Many days, I have no fucking idea. These collective days have eroded my confidence, my sense of self, my ability and desire to be present in my life and my hope for the future.

The last two weeks have been excruciating due to tapering a medication (I think). We started by cutting my dose in half and I have felt nothing but raw, burning anxiety and suffocating depression. Or maybe these feelings are attributable to a mixed-state episode (i.e. hypomania and depression at the same time). There really is no way to tell the difference. All I know for sure is that I feel more “sick” than I have in over 7 months. I feel like every single bit of progress I have made toward minimizing the symptoms of my bipolar disorder has been lost. And I have acted horribly because of how I feel.

I am constantly irritable and have little to no patience, so I do not behave as a have and should towards my children. I get upset about the smallest transgressions and I am quick to say no to every request that I feel would be too much for me. Sometimes I yell. I have no tolerance for messiness or loudness or things that are not safe (which is pretty much everything in my addled mind). But messiness and loudness and doing things that may not be safe, but won’t cause serious harm, are inherent parts of childhood; these are things that parents live with everyday and ignore, within reason, because they are part of the package of having tiny little humans that you love with all your heart. But I can’t see that most days. Or, worse, I can see it but I can’t stop myself from getting upset anyway.

I have also be consistently down, negative, unhappy, tearful and hopeless. I am always upset, never light-hearted. I refuse every request to try something new. I don’t want new. I don’t want old. I don’t want anything except to hide from my family and the rest of the world so that I don’t have to feel my feelings, so that I can pretend, if only for a few minutes, that I am alone in world, without the responsibility to care for or love anyone.

My rational self knows and understands that my thoughts, emotions and behaviors described above are the result of a medication change and/or my illness. But other parts of myself can’t understand that, or hold on to that understanding. Instead, I feel that my emotions and behaviors are me, true illustrations of the person I really am. I feel that I am a horrible mother, that I should not have had children because I cannot care for them properly or love them as they deserve to be loved. I am heartbroken that my behavior has harmed them and will continue to harm them far into their futures. I apologize constantly, but that is not enough. They are too young to understand why I would do such things in the first place. All they know is that their mommy isn’t as nice to them as she used to be, that maybe she doesn’t love them as much as she once did.

Again, I read over the above paragraph and I know that those sentences are not true. I am not a horrible mother. I am a good mother who loves her children fiercely, who still manages to comfort them in the night despite her powerful sleep medication, who kisses every ouchie and sing songs (off-key) whenever requested. I never miss the morning routine, dinner, bath time or bedtime. I clean their clothes and make sure they haven’t outgrown their shoes. I manage their school supplies and their doctor visits. Even at my worst moments of illness, I do these things, and more, because I am a good mother who loves her children. That is the truth about me and my life, whatever my illness or meds might make me feel. But my truth is not stable. It is vulnerable and tenuous.

If I am going to survive living with this illness, I have to hold on to my truth. I have to build it up, put a wall around it and defend it with all the mental strength I have left.

I have an illness but it does not have me. I am still the one in control of my life. I will not surrender. I will fight for who I know I truly am. I will do it for my kids, my spouse, my family and my friends. I will do it for me, because to live my life in any other way would not be a life worth living.

There are no words

I have read a number of stories, blog posts, etc. about Chris Cornell and depression over the past few days. His death is an incredibly sad cultural loss and personal loss for his loved ones. It also exemplifies the simple truth that depression is indiscriminate. It does not affect a certain type of person; it is not the result of a character flaw or a lack of personal ambition; it does not care what you have achieved or how much you are loved. It is an illness caused by a chemical imbalance in the brain, a chemical imbalance that exists among millionaires and rock stars as well as the people who live next door. It effects the moms and dads and grandparents and teenagers who you know and even love. It is so much more common than you realize. Knowing this fact, really internalizing it, is a very important, powerful step towards de-stigmatizing mental illness and providing true support, even empathy, to those who suffer from it.

Even so, simply recognizing that depression is an illness is not enough. We need you to believe that depression is not something that can be “fixed” through personal effort or optimism. We need you to acknowledge that dealing with depression requires serious, often long-term treatment. It also requires fucking hard work just to survive. Many people who suffer from depression, myself included, put in more emotional work just to get to “normal” each day, than many people expend simply living their lives.  Having someone we love truly believe these truths about depression is an incredibly validating experience. It makes us feel seen and heard. It makes us feel less alone.

I have found the most difficult part in bridging the gap of understanding between myself and my loved ones is my inability to adequately describe what my depression feels like. Yes, it is caused by a chemical imbalance, but an imbalance that doesn’t cause any adverse feelings would be irrelevant. It is the feelings caused by the imbalance that make depression what it is. And those feelings are different for each person. However, in an effort to give some sense, some words to what depression can be like, I offer up my personal experience and feelings:

  • Depression takes me back; it examines every mistake I’ve ever made and forces me to physically and emotionally experience those past events. I feel the chest tightening, heart-wrenching pain of every loss. I feel the waves of shame starting in the pit of my stomach, traveling through my chest and then my face. I examine every major decision I ever made and sob at the imagined joy I may have missed.
  • Depression critically examines my current life circumstances and meticulously points out every area in which I am failing. It tells me, viciously and repeatedly, that I should be a better, more patient and loving mother who spends more quality time with her children. It tells me I spend far too much time on the mundane tasks of day-to-day household management rather than with my family. It make me feel like an inferior partner to my husband, who I now depend on financially; that I ask too much; that I don’t contribute enough; that I am a burden; that eventually he will leave me.
  • Depression also robs me of hope for the future. It tells me that my pain and regrets will never go away. I feel as though nothing will ever change or get better; that I will spend the rest of my life feeling overwhelmed by mothering three children, satisfying my husband’s emotional needs and keeping my own head above water. Depression makes me feel like no matter what treatment I seek, or how religiously I adhere to any doctor’s recommendations, I will never feel better, not in a sustained way.

Depression makes me feel all of the above, day in and day out, nearly everyday of my life. It is exhausting. It feels so unfair. Even though I know it is not my fault, even though I constantly preach that message, I still feel like it is my fault much of the time. How can I not? It is my own mind after all. Why can’t I just control it?

But I can’t, I can’t control it, or stop it, or fix it. Believe me, I’ve tried. Depression is part of who I am. It always will be. It is my monster. My internal demon that I will never be able to truly share with anyone else. I bear the burden. I will carry it, always. I will carry it as far and as long as I can.

 

Weaving a parachute out of everything broken

Things have been rough the past few weeks. Major depressive episode plus extreme anxiety is the most awful mental state I have ever experienced. I walk around all day, every day worried, annoyed and even angry that everything in my life is a mess (e.g. my house, my backyard, my car, my kids, my professional life) but am too depressed to do anything about it. In other words, I am simultaneously furious about all the things that need to be “fixed” and overwhelmed by the idea of fixing any of them. It all feels too pointless to bother.

As I’ve struggled, my ruminations have gone from broad to very narrow. Now, my mind endlessly pleads to go back, back to being the person I used to be before all of this shit happened. I remember years of consistent psychological stability; kicking ass at multiple tough jobs; reading great big books because I could both concentrate and sit still. I remember eating amazing food on dates with my husband, making him laugh from across the table without having to consciously work at it. I remember being good and relatively content — as a person, a friend, a wife, a co-worker — without having to do anything except be myself.

All during the year leading up to my breakdown, I felt my confidence, my sense of self, my values and beliefs, slipping away. People close to me can readily attest to my abnormal behavior, including substance-abuse, lying, recklessness and poor work performance, assuming I showed up at all. There were days when I got up, got dressed, drove my son to preschool and then simply drove back home and went to bed, instead of going to work. By the end, all I could do without significant effort was sleep and cry.

Taking leave from work to go to treatment was a very hard and, to me at the time, a very shameful decision. It felt like admitting I was weak, like pulling back the curtain and revealing I wasn’t who everyone thought I was after all. I was an imposter, a fake and all my efforts to prove otherwise had not only failed but had broken me in some fundamental way.

Despite my misgivings, I left work and went to IOP and doing so probably saved my life. Without a proper diagnosis and proper medication, I doubt I would still be here. But that doesn’t mean things are easier now. Being diagnosed with late onset bipolar disorder 2 did not provide a map for getting back to who I was. It confirmed that the woman I was no longer exists.

Often, I feel I am walking around inside the shell of the person I used to be, looking at the world through her eyes, living in her house with her family, mothering her children and working to build a strong relationship with her husband. But I am not her.

We look quite similar on the outside, but on the inside we are two different people. The small cracks that appeared in my mind after the twins were born grew into canyons under the pressure of mothering, working and caring for our household, without taking any time to care for myself. Eventually, those canyons split entire continents of psychological existence apart and those continents floated away. I do not think about my life or live it the way she did. And it breaks my heart to know she is gone, that I will never be her again.

There is no going back in time to when I did not have a bipolar disorder, or three small children or a sense of ease and confidence in being myself. There is only me as I exist today. 

There is the hard work to stay well and to care for my kids. There is the hard work to dig deep into my marriage so it can be the rock our kids stand on to feel safe. There is the courage to be vulnerable in asking for what I need and expressing my disatisfsction with the status quo without knowing what the response will be. There is the constant internal battle between what I know I can do and what think I should do to contribute to our family’s well-being, while also respecting my own needs and health. There is guilt and relief, fear and freedom. Most of all, there is a lack of certainty about pretty much everything.

What I do know is that she, the woman I was before, is gone. And mourning her is wasted time and energy better spent living my life now. “Unanticipated” is not an inherently negative word. It is synonymous with, among other words, fortuitous, stunning and amazing. I plan do whatever it takes to eventually use one of those words to describe the result of the unanticipated turn of events in my life. 

I will weave my parachute out of everything broken; my scars will be my shield; and I will jump.

 (The italicized sentence above and the title of this post are paraphrased excerpts from William Stafford’s poem, Any Time, which, like all of his poetry, is fucking amazing).

 

 

 

 

 

Please describe the source of your condition

I’ve been wrangling with some insurance folks lately. The title of this post, or some iteration thereof, has appeared in every request for information I have received: Please describe the source of your condition. I suppose if I had a broken leg, this might be a reasonable request, but for any mental illness, this request is practically, and most likely scientifically, impossible to comply with.

The first time I received a form asking me to describe the source of my bipolar disorder, I just stared at the form for awhile and then laughed out loud. The absurdity of the request was confirmed when I realized the form provided less than four blank lines to write my answer. Since then, some forms with the same request have allowed for the attachment of additional pages “if needed.” The best idea I could come up with to be as accurate as possible was to write nothing except “see [most commonly used textbook on mood disorders, most current edition]” and also maybe “Talk to my doctors. You already know who they are and have signed releases to speak with them. However, even they probably can’t give you a comprehensive or entirely correct description of the source of my condition; but they are a hell of a lot more qualified to try than I am.”

Recently, a real live insurance company person asked me to provide this same information over the phone. I asked, only half-jokingly, how much time he had. I also told him I wasn’t qualified to answer the question and that he should speak to my doctors instead. He insisted that I provide an answer to the best of my ability and so I did. My unqualified, minimally researched, extremely speculative description of the source of my bipolar disorder went something like this:

My Genetics – I have a family history of bipolar disorder on my father’s side. While none of the people with this condition are part of my immediate family (e.g., father, mother, brother) they are only slightly removed. All of them are women. I also have a family history of substance abuse, an indicator of possible bipolarity.

My Brain Chemistry – Some researchers believe that neurotransmitters, like serotonin and dopamine, don’t function properly in people with bipolar disorder. Given that I was diagnosed with unipolar depression and have taken some kind of Selective Serotonin Reuptake Inhibitor (SSRI) since I was 18, it seems highly likely my neurotransmitters are dysfunctional.

My Postpartum Experiences – Some researchers believe that suffering from a postpartum illness like postpartum depression (PPD) or postpartum anxiety (PPA) is an indicator of bipolarity. I experienced significant PPA after our oldest was born and may have had significant PPD after our twins were born until that illness combined with other factors to become bipolar disorder. Also worth noting is the fact that women with bipolar disorder (known or unknown) who are pregnant or have recently given birth are seven times more likely than other women to be admitted to the hospital for their bipolar disorder.

My Hormones – In brief, pregnancy screws with your hormones in significant ways. Some go up, some go down, some make you puke, some make you super flexible, etc. Logically, a multiples pregnancy results in greater hormonal changes. Researchers believe that, particularly in women, hormones may play a role in the development and severity of bipolar disorder. Some possible examples of my hormonal train wreck after giving birth to the twins are that my pin-straight hair became wildly curly (hormones change the shape of hair follicles); I had no cycle despite not nursing; and, I had no acne, not one pimple, for over a year. Once I stared my bipolar meds, my hair became straight, my cycle regular and my acne plentiful.

My Life Circumstances – Bipolar is exacerbated by lack of sleep, an irregular life schedule or structure, and high levels of stress. Beginning in August 2015, I had two newborns plus a three year old, no predictability to my nights or days, very little sleep, and a great deal of stress, both home and work-related. Additionally, I took very little time for self-care because I believed my time was better spent doing other things.

Take the above five factors, put them in a cocktail shaker and shake for about 14 months. Open, pour and out comes my bipolar disorder II.

As you can tell from the above, I do not believe that I have always had a bipolar disorder and been misdiagnosed and improperly medicated for decades. For a long time, I experienced symptoms of depression, but so long as I took my Zoloft things were okay; often better than okay. After the twins were born, my Zoloft stopped working. We tried other antidepressants, antipsychotics, everything that seemed potentially helpful. None of it worked. Finally, I left work to enroll in an Intensive Outpatient Treatment Program (IOP) and that’s when I was first diagnosed with bipolar disorder II. Perhaps that diagnosis could have been made earlier in the year, but I don’t think it could have been made before August 2015. In short, I believe my genetic tendency for bipolar disorder was triggered by my physical, psychological and life circumstances at some point during the 14 months after my twins were born. This triggering resulted in a full-blown illness.

So that’s my description of the source of my condition. It is not well-supported by my educational background or research. I could not testify as an expert about it in court; but I am the best possible fact witness.

From what I can tell, there is very little known, as opposed to hypothesized, about the source(s) of bipolar disorder. The symptoms are often easy to spot but why those symptoms arise in a particular person is, at best, indeterminate. The above explanation of what happened feels correct; it makes sense to me. And that may be as much as I can hope for, as close to the truth about the source of my bipolar disorder as I will ever get.