Irritability has been a problem throughout my life. Sometimes it’s felt uncontrollable, and now and then it’s definitely got me into trouble. My irritated mood has a tendency to deploy my mouth and vocal chords before my wiser mind can intervene, and I’m uncomfortably aware that so far I’ve got off quite lightly in terms of consequences for my actions. Considering that until this year, I didn’t recognise any of my symptoms (not even elation or sleeplessness) as belonging to “that diagnosis I rejected back in the 90s”, I suppose it’s not at all surprising I didn’t join up the dots where periods of irritability were concerned. If there’s one major problem with the term “bipolar”, it’s that it implies an either/or mood, suggesting that the bipolar person must swing between depressed and (hypo)manic. Mood states involving elevated energy levels (sleeplessness and agitation) coupled with negative emotions (anxiety, distress, irritability, hostility, etc), fit neither the slowed down, sleepy state of clinical depression, nor the buzzing, elated state that is hypomania. No wonder it sometimes takes a while for many people to work out that their irritability is just as much a hallmark of their bipolar as hopelessness or euphoria.
Around the time of my recent crisis, my predominant emotions were panic and despair, potentially a very dangerous state to be in when combined with high-speed thoughts and physical agitation. Since then, partly due to a big increase in prescribed antipsychotics, my energy level has gradually decreased and the panic has mostly dissipated. In the past week or so, I have had only slightly elevated energy levels, but my predominant mood has shifted towards anger and irritability, with a generous seasoning of resentment and hostility. I’m really grateful not to be in the grip of unmanageable panic any more, but feeling angry and irritable all the time definitely brings its own set of uncomfortable challenges.
One of the reasons I feel so bad when I respond to someone in an irritable or hostile way is that it very much goes against my personal values. Those values are informed by the way I was brought up with, and the spiritual ideals I have been introduced to as an adult. I have always considered it important to treat other people with respect, just because they are human beings, not because of their status, wealth or connections. I was raised to look for the good in people, even if they seemed strange or frightening to me, and to think about how and why they might act as they did. This attitude has underpinned my career choices, which have always involved working or volunteering in “the helping professions.” Being in a perpetually hostile mood is the very antithesis of this approach. The generosity I normally extend to my fellow humans vanishes into thin air. Crowded places are the worst: buses, undergrounds trains, supermarkets, shopping centres, all apparently populated by idiots who are deliberately attempting to impede me or jump the queue or hit my shins with their wheelie suitcases. People who are paid to try and help me (such as my pharmacist and psychologist) seem patronising, and their advice appears trite. Anyone who disagrees with me – and there were plenty of those last week on Twitter, with the public sector strikes in the news – is an imbecile, who lacks the intelligence to understand the issues. I’m well aware that my reactions are unnecessarily belligerent, antagonistic, arrogant, snarky, and argumentative, and I hate it.
I’m quite good these days at cutting myself some slack when I’m depressed, because I know I am in an abnormal mood state, and that this distorts my thinking and reactions. I am also getting better at being gentle with myself if I handle a situation badly because I am hypomanic (for example, talking too much, being insensitive, or spending too much). But I find it very hard to attribute an unskilful irritable social interaction to my bipolar. I feel much more strongly that I “should” be able to control my irritable feelings and hostile reactions, and I’m quick to label myself “a bitch” and my behaviour as “bad”. In other words, despite the fact that this has been a lifelong problem, that very clearly comes and goes in episodes or phases, I still see angry feelings as coming from my character, rather than my illness. I can’t help wondering if there is a gender element to this; another lesson from my upbringing was the unconscious message that men get angry, but women put up with things and carry on, no matter what, and it’s certainly true that in our culture, anger is not generally perceived as a positive or attractive emotion for a woman to display.
There is some truth to the idea that depression is anger turned inwards, and the implication can be taken from this is that anger is somehow a more healthy response to have. Depression is indeed an abnormal state in which, to borrow Thomas A Harris’ famous Transactional Analysis model, the sufferer becomes convinced that “I’m Not OK, You’re OK.” Thought patterns tend to focus on the depressed person’s own perceived guilt, inadequacy and uselessness, placing a sense of blame squarely with sufferer, rather than, say, the relative that abused them, the boss that overworked them, or the perpetrator who committed a crime against them. Moving from a position of self-blaming, internalised anger to becoming angry with someone who deserves it is indeed a positive reaction. But my bipolar anger is not healthy anger, because it is not directed at legitimate targets. It is the scattergun effect that comes from a core sense that “I’m OK, You’re Not OK.” Everyone else is wrong, from the strangers on public transport, to the highly trained professional or the well-meaning friend offering advice. All wrong, says bipolar anger, wrong, wrong, wrong and should behave differently. Bipolar anger is really part of hypomania, which is very much a double-edged sword when it comes to its reaction to other people. At its most positive, hypomania represents an abundance of “I’m OK, You’re OK” – not only are we all OK together, we are perfectly lovely! At this level of hypomania, I walk down my street and have life-affirming exchanges with everyone I meet. A kid whizzing dangerously near my legs on a scooter is cause for an “awwww!” and I’m keen to step aside to let others into a shop or a bus before me. But as hypomania tips into the arrogance and narcissism of grandiosity, I begin to assume a position of, “Well, Sure, You’re OK I Guess, But I’m Special”. From here it’s only a short hop over to bipolar irritability.
I’m trying. I really am. I’m actively concentrating on trying to wish people well, employing metta mediation and cognitive techniques to address attribution error (i.e. examining whether it could be true that “maybe she tried to get on the bus before me because she didn’t realise I was waiting here first”, rather than automatically assuming that my initial reaction of, “WTF! Look how she just pushed in front of me because she’s so selfish!” is true). But my emotions still seem to be able to operate my body faster than my conscious thoughts can; as the lady moves to step onto the bus, I feel my neck whip round and my eyes assume a stare which, even to me, feels like the Look of Death. I would not be surprised to learn that there are lasers emitting from my pupils. Red ones, probably. The lady falls back pretty quickly, and I board the bus with a mingled sense of victory and shame.