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.
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 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.
One of the reasons why it is problematic to talk about depression, mania and hypomania is that those words may mean many different things.
For instance, bipolar and unipolar depression are called the same, but they are not the same. In most cases, unipolar depression is caused by past events, and dealt with using anti-depressants and therapy. In fact, therapy is the better solution of dealing with unipolar depression, as it offers a possibility of removing the trigger that’s been hidden deep inside for years, sometimes decades. Anti-depressants deal with the symptoms, and are sometimes absolutely necessary because a person in deep depression is unlikely to respond to therapy (or to anything at all).
I got diagnosed on my 35th birthday.
It wasn’t the present I expected. Truth be told, I watched the Stephen Fry documentary a few days earlier and said to my boyfriend “hey, that’s interesting, but it looks like I might not be depressed but actually bipolar”. You’d think I wouldn’t be too shocked with the diagnosis after that. But I was, extremely. I cried on my way home. This wasn’t meant to happen to me. I already had depression, surely that would be enough? And this period when I felt like I owned the Earth, when I walked the streets in my heavy army boots like they belonged to me, the time I spoke with gods and they responded, when I started a business fully convinced I’d make piles of money… this was all fake? All an illusion created by a bipolar brain? It was an awful lot to take, and especially on my birthday.
I don’t really celebrate birthdays, but I invited a friend over and bought a bottle of whiskey. I dried out more than half of it, while he was getting increasingly worried. I cried, I laughed, I cried more. This friend saved my life the morning after, when I woke up with mother of all hangovers and father of all depressions, determined to kill myself. I didn’t see a way out at that point. I thought: this was it, my life is done. The only sensible option seemed to slash my wrists and bleed myself to death. First, though, I called the psychiatric hospital that was meant to take me on board in a week, where they told me in a dry tone I am blackmailing them by talking about suicide and I should go call my GP. Then I called my GP who insisted I call the hospital again. Then I ran out of strength and started harming myself. And then my friend called and checked on me, and since I refused to tell what was going on, he came by and took me to a psychiatrist in person.