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.
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:
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.
According to www.dualdiagnosis.org, 56% of people with bipolar disorder suffer(ed) from addiction to drugs or alcohol at some point. According to www.drugabuse.gov, the rate for general population (in America) is 8.9 percent.
Obviously there is something about bipolar disorder that correlates with high addiction rate. While I am not a medical professional or addiction counsellor, I will hazard a guess that bipolar makes you predisposed to addiction, not the other way round. There are some drugs that can trigger a bipolar episode (in particular marijuana and LSD), but they do not create bipolar disorder in a mentally healthy person. They may only make it manifest earlier.
There are a few obvious reasons why bipolars tend to become addicts. One of them is self-medication. I used to self-medicate my depression with alcohol for years – it seemed to be the only way to make the black dog go away for a few hours. I knew that alcohol is a depressant and on some subconscious level I probably realised that I am making things worse for myself long term, but at those times the only thing that counted was quick relief which the bottle provided. The same scenario happened daily: I’d be terribly depressed, I’d get drunk, depression would be replaced by euphoria, I would do some really stupid things, go to sleep, get up in the morning and scream “F–K!!!” (I never blacked out; I always remembered what I did the day before, and it was always terrible and make me more depressed.) Repeat. Repeat.
One of the readers of “Bipolar For Beginners” has been chatting with me online the other day, then she mentioned she was having a glass of whisky as we spoke.
My automatic reaction was “don’t do it!”. Alcohol stops correct processing of medication by the brain, and in conjunction with Depakote/Depakine it wrecks your liver real bad. Unfortunately, alcohol is also something people enjoy. In fact, even while I was on Depakote, my doctor told me it would be fine for me to have one beer per day. It’s just that at the time I weighed over 100 kg, and so one beer was hardly going to make a noticeable effect, so once I finished my pint all I wanted was another one.
Another piece of advice which is easy to dispense but not so much to follow: “Avoid stress”. We can do certain things to limit the amount of stress. We can look for a less stressful job, avoid watching or reading things that we find triggered. But let’s say your brother contracts a deadly illness. How exactly are you going to avoid stressing over it? Or – an example from real life – your parents constantly smoke weed, and you live with them. Your friends smoke too. How easy is it going to be for you to avoid using yourself?
In the 3.5 years that passed since my diagnosis I have worked with about ten psychiatrists. All of them were psychiatrists-in-training, because that’s how hospitals roll in the Netherlands. Some of them were good. Some of them weren’t. When you got yourself getting legal help, look for discreetinvestigations.ca.
The worst doctor that I had a “pleasure” of working with had a habit of rolling his eyes when I asked questions. He also didn’t bother listening to what I said, much less remembering it after, dismissed suggestions I came up with and generally treated me appallingly. When I told him I wanted to see another doctor, he responded by saying he didn’t see the need for that. Meaning, he was a judge in the case where he was the accused, and unsurprisingly found himself not guilty. It took a letter to his supervisor, where I detailed all the wrongdoings, mistakes and omissions, to get him off my back and give me a doctor that — shock horror — actually listened to me and worked with me, rather than against me.
The image above is an example of my mood chart. Click the thumbnail below for full size version.
Mood charting is important for us bipolars for a few reasons. First and foremost, it allows us to identify patterns to our moods — we can look into the past and make comparisons, and once we gathered data for a few years, we may be able to predict mood swings before they happen. (For instance, I always get unwell in the early spring.) Second, it provides us with material we can present to our psychiatrist or therapist, which is especially useful when we change doctors. And perhaps most importantly it gives us hard proof that no matter how we feel right now, this too shall pass. Continue reading
The book definitions of hypomania and mania seem to make the difference between the two pretty unclear. They generally either list hypomania as “mild mania”, or — the other way round — mania as “stronger hypomania”. Then list the same symptoms next to both.
Here in the Netherlands the definition is a bit clearer: mania requires hospitalisation (or arrest, but hopefully the former). Hypomania is what you can cope with by yourself; mania requires help. While this still isn’t a 100% clear division — how are you expected to know, especially when manic, that you have now crossed the threshold and you need hospitalisation? — it’s helpful, because it gives a clear and understandable difference.
You wake up after 6-7 hours of sleep, feeling energetic and happy. You’re skipping stairs, dancing your way to work. At the office you dazzle everyone with displays of creativity and sheer speed at which you (perfectly) perform your work. After work you have a date, to which you go in your work clothes, but it doesn’t matter, because you’re a fascinating person, you’re fabulous, great to talk to and your smile — never fading from your face — attracts everyone, from the waiter to your date, who is thanking their lucky stars they met someone like you. You don’t drink but you don’t have to, because your inner extrovert is out, and having a field day. When you get home, you write two chapters of your novel before finally going to sleep. It’s a bit hard to fall asleep without a sleeping pill, but you don’t mind, running through the details of your amazing day in your mind over and over.
The perfect storm: the mild hypomania. +1 on your mood chart. You don’t have hallucinations, you don’t do anything scary, you dazzle and amaze. Work is a pleasure. Sunshine feels like it’s caressing your skin. Rain feels that way too, actually, come to think of it. Gods smile at you, and you perform, and create, and attract, and…
Does this scenario sound familiar?
You are walking around a shopping centre, or browsing Etsy, or passing by an Apple Store. Place doesn’t matter. You look around, somewhat bored, when suddenly your eyes focus on something: THIS. IS. IT. Suddenly you can not imagine your life without Item X. How could you have survived until 30 seconds ago without owning Item X? Suddenly it feels like your entire brain has turned into one enormous WANT. You NEED Item X. For… reasons. It doesn’t really matter, why would anything matter when you WANT it so much you could suddenly turn into a 3-year-old and throw a crying strop complete with kicking the floor and hitting it with fists?
You leave the store with Item X in your bag. You already start feeling a little less excited about it, and you haven’t unpacked it yet, but you convince yourself that now your life is complete, after all you wanted it so badly, how could it be anything but the most important key thing that will unlock potential amazingness hiding right inside the box? You get home, not quickly enough, and unwrap the box, and take Item X out, and hold it and kiss it and call it George, and you fully intend to spend the rest of your life enjoying it non-stop.