“I don’t think I’m sick”

Oddly enough, one of the symptoms of both unipolar depression and all phases of bipolar disorder is the idea we aren’t sick.

In depressed phase, it is associated with lowered self-esteem. Together with all other negative thoughts comes the idea that we are just lazy, and we’re just pretending, and we don’t have depression at all. (This is greatly aided by having relatives or friends who provide us with helpful phrases along the lines of “why don’t you just pull yourself by the bootstraps” and “you know, you could just try not to be depressed”.) And so we find ourselves on the floor, curled into fetal position, thinking we’re just imagining all this and in fact don’t have any reason to feel bad, so why don’t we get up and do something. Then we don’t get up and we don’t do something, because depression won’t let us move.

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Guest Post: Walking Sir Winston’s Dog

This is a guest post by Rob Robinson. Used by permission.

Since I know that a number of my closest friends on here live with clinical depression and the attendant illnesses that derive from it, I thought it might be appropriate to post some thoughts on the matter, both for sufferers and non-sufferers. These are based on personal experience and also experience of working as a mental health lecturer, so they’re a mixture of life and theory.

What clinical depression IS – and what it isn’t….

Depression is not a lifestyle choice. It’s the most debilitating of illnesses and nobody chooses to suffer with it. The actual cause (as ever the medical profession is obsessed with finding a concrete, biological cause, and preferably one that can be treated with medication…) isn’t proven, though certain chemical imbalances in the brain are thought to occur in the sufferer. As with all mental illnesses, it engenders a great panic in medics because it can’t be ‘seen’ – it is diagnosed through observation, not scans or biopsies – and because it is a disorder of perception and thinking, both functions of the mind, and the mind happens to be contained within the brain, focus of research tends to treat it as a brain malfunction. The evidence for this is actually alarming sparse. Once the two clear physical conditions that might affect the brain – that is, organic disease such as Alzheimer’s, and trauma – where the organ has actually been damaged, as in taking a huge blow – are ruled out, then it all gets into a bit of a mushy grey soup as far as the most severe mental illnesses are concerned. Ironic, given that the brain might be described as mushy grey soup itself….

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How to explain depression

I often speak to people who don’t understand the nature of depression at all. They are convinced they’ve been depressed — “once after a break-up I cried for three days and listened to Nick Cave a lot, but I just pulled myself together and stopped being depressed”, which kinda suggests you’re just too weak or lazy to un-depress yourself. All it takes is pulling yourself up by the bootstraps, they suggest. Why don’t you stop being depressed? It’s easy!

Except, of course, it isn’t, and they have no clue what they are talking about. Bipolar depression is a chemical imbalance in the brain. (Apparently latest studies suggest it is a sort of inflammation.) You can’t stop being depressed any more than you could stop having cancer. There are ways to improve your mood, but when you’re in the darkest pits, those ways aren’t likely to work. For instance, physical exercise helps, but knowing that doesn’t help much when you can barely get dressed without assistance and taking a shower seems to be the same level of difficulty as climbing Mount Everest without oxygen tanks.

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Did the Germanwings pilot suffer from bipolar disorder? *TW*

Andreas Lubitz’ name started appearing in my Google Alert a few days ago with speculations on whether he was depressed, or, in fact, bipolar. But a confirmation showed up yesterday:

In the days running up to the Germanwings crash, Andreas Lubitz repeatedly logged on to his computer under the name “Skydevil” and searched for information on cockpit security, it has emerged.
Prosecutors in Dusseldorf revealed last week that the 27-year-old co-pilot had looked up suicide methods and medical conditions but now a German newspaper has claimed to reveal the exact words used.
[…] From 16 to 23 March – the day before the disaster – he repeatedly searched terms including “bipolarity”, “manic depression”, “migraines”, “impaired vision” and “acoustic trauma”, investigators with access to a tablet computer found in his apartment told the newspaper.

I can’t say I’m surprised. Experts in my Google Alerts claimed, rightfully, that a depressed person doesn’t come up with a detailed plan to die, then execute it, taking 150 people along. Most depressed people, when suicidal, either lay down on their sofa curled into fetal position, or, when a sudden boost of energy comes, harm/kill themselves immediately, without waiting for a week until the right chance comes along.

One of the possible mind states in bipolar disorder is called dysphoric mania. Essentially it means that the person afflicted suffers similarly as during depression, but has the manic energy, creativity, anger and pretty much random other symptoms of mania, like delusions of grandeur. If this was the case of Lubitz — IF, I said — what he has done becomes understandable. (Not justifiable!) A person with delusions of grandeur thinks of themselves as being on a whole different level than “normal” people; when they’re creative, they come up with elaborate plans; when they’re energetic, they put those plans into life; when depressed — see the dysphoric bit — they want to die. Putting all those together would mean — IF I am correct — that people on board of the Germanwings plane didn’t matter to the co-pilot. He wouldn’t mind them not being there at all. The only reason the captain mattered was that he had to be removed from the cockpit. IF Lubitz was in dysphoric mania, he didn’t think of himself as killer of 150, he was just finishing off his personal life story, possibly feeling proud that he is flying an Airbus at his last moments of life.

Should bipolars be allowed to be pilots? I can’t give you the easy correct answer to this question. A lot of people drink alcohol. Should they be allowed to drive? You can’t tell for sure that they will never try to drive drunk or hungover. In many countries, especially those with tight anti-abortion laws, women throw away their infants to die. Should people be forbidden from having sex?

It is an incredibly harmful things when media try to extrapolate single cases onto the whole population. Would papers all over the world be so quick to report Lubitz’ searches if he googled “Barbie dolls” and “strawberries”? I am about to start a second draft of a fictional novel I am writing, and I have been googling “suicide using medicine” and “what happens to the body in the morgue”. If I got hit by a train tomorrow, and was famous enough to warrant papers to go through my Google searches, I’d look very interesting to the media.

A great majority of people suffering from bipolar do NOT kill themselves or others, do NOT fly planes into mountains and generally live rather boring lives (especially if, like me, you follow doctors’ orders to a tee). But newspapers never report “An exclusive: John Doe, who suffers from bipolar disorder, hasn’t killed anyone today”. They never write “Jane Smith, who does NOT suffer from depression, bipolar disorder, schizophrenia, narcissistic disorder or antisocial personality disorder, killed her husband by hitting him on the head with a frozen trout. Should we stop selling fish to mentally healthy people?”

My next plane flight is planned for July. When boarding, I will not be wondering whether my pilot: suffers from a mental illness; is drunk; high on speed; just got served divorce papers; his son committed suicide; daughter announced she’s lesbian; does his mortgage exceed the value of his house; did his favourite football team lose 6:0 last night. If you search well enough, you can find a reason any person should/could be forbidden from flying planes, driving buses or trains. I am deeply worried Lubitz’ case will take the public view on bipolar disorder ten years back. I hope and pray that what happened will not lead to a blanket “mentally ill people should not perform any public jobs” sort of “solution”. My name is Grant, I have bipolar disorder, and I am not Andreas Lubitz. And neither is any bipolar person that I know. Don’t tar us all with the same brush.

Photo: Michael Mueller, AP

Internalised stigma

A friend has told me he met a really fantastic girl. She’s everything he dreamed of. They’ve been dating non-committally for a few months, and now he asked her to be his girlfriend. Her response? “I can’t be anybody’s girlfriend,” she said. “I have bipolar disorder, and it’s a terrible illness. I’m just not fit to have a relationship, any relationship at all.” He asked me how he could convince her. “You’ve got bipolar,” he said, “and you’re in a relationship. It’s possible to have a relationship while having bipolar, right?”

Of course it is. But then the problem with bipolar disorder is that it doesn’t actually make anything impossible. You can be a respected professor of psychiatry like Kay Redfield Jamison. You can be a super-popular actor and TV personality like Stephen Fry. You can be a chart-topping singer like Robbie Williams. You can be married, have kids, a good job. It’s just that for us it’s harder than for “normies”, and some of us overestimate the difficulty level based on what we heard and read about ourselves. And this is where internalised stigma comes in.

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