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.