This week I’ve been reading A Lifelong Journey: staying well with manic depression/bipolar disorder (it’s quite old now as it was published in 2005, but it remains in print for anyone interested). At the book’s heart is a collection of first-person narratives by people with bipolar, which the author, Sarah Russell, has grouped into thematically linked chapters (e.g. “Beginning the journey”, “Choosing medication and other treatments”). I have been particularly struck by one contributor, a 54 year old GP named Robert, who is unequivocal in his view of bipolar as an illness which is entirely separate from his sense of self. “My strategy,” he writes, “is to see the problem as the manic depression and not me as a person. I separate myself from the illness. I see the need for me to be in control of the manic depression, so that it doesn’t influence my life too much” (p15).
I suppose you could say that’s a very rational way of looking at bipolar, particular for someone who is heavily invested in the medical model. I have bipolar; bipolar is an illness; illness is something to suppress, control or cure. This is the way most people, quite understandably, view chronic physical health problems, for example diabetes or high blood pressure. Most people develop this type condition rather than being born with it, so they have to learn to accept both diagnosis and the corollary that they most likely have the illness for life, and there are certain things they must now do (see medical practitioners regularly, undergo tests, take medication, make lifestyle changes) if they wish to control the illness. Otherwise, the illness is likely to rule – or even pose a risk to – their lives.
Much of the above holds true for bipolar. So why was it that when a good friend said to me the other day, “I wish I could take away your bipolar!”, I froze in horror? After all, she had been driven to say it after more than a year of watching me struggle as my moods move back and forth. Over the years, untreated bipolar has cost me friendships; exacerbated relationship problems; terminated two career choices and interrupted another; made me periodically unable to look after my own children; and driven me to want to take my own life on many occasions. Why wouldn’t I want someone to wave a magic wand and take all of that away? The thing is that, unlike Robert, I am not sure I can say that my bipolar and my self are separate entities. My symptoms started very early in life, so by the age of 12 I was experiencing both depressions and what I now recognise as hypomanic symptoms (my current urges to run in the street now helps me make sense of the “itchiness” in my muscles which had me struggling not to bolt from the classroom). My unchecked bipolar symptoms shaped my adolescence, and that stage of life isn’t referred to as the “formative years” for nothing. Bipolar has moulded my character, and although I know I have plenty of flaws, overall I like who I am. I also know that I’m far from the only one to feel this way – many people who blog or tweet define themselves as “a bipolar person” (or bear!) or use the adjective “bipolar” to refer not to the condition, but to themselves (e.g. “I’m bipolar, so anything that messes with my sleep patterns is really bad news.”)
Then there’s the fact that bipolar, unlike many mental disorders, has aspects that are perceived positively (by both people with a bipolar diagnosis, and by the general population). Hypomania is like an extension of some aspects of my personality which serve me well in life. I like to be creative. I enjoy being “an ideas person” and “a people person”. I love to network, to develop and sustain work relationships and friendships by being open, charming and a little bit flirtatious. It’s also useful that when required I can focus single-mindedly on a task until it’s done. Hypomania takes all of these qualities that are in me, and make them more so, so that I find it very difficult to know where the line occurs between what is “me” and what is “bipolar”. It’s exactly that kind of imaginative, flexible thinking that Tom Wotton explores in The Bipolar Advantage, and which some bipolar people working in creative fields are scared of losing if they accept medication. And don’t let’s forget that hypomania itself feels great. It expands the doors of one’s perception (as I recently discussed over at the International Bipolar Foundation) whilst avoiding almost all of the negativity that comes with full blown mania, irritable mania or a mixed episode. Some of the experiences I’ve had while hypomanic have been so glorious and transcendent that there is no way I would give up having lived through them.
I can’t even say that I could wholeheartedly give up all the years – and adding up all the episodes in my life, it must indeed be years – that I have spent clinically depressed. Every day that I spent depressed was, by definition, horrible. I of course regret that so much of my life has passed in that state, particularly as it was at its worst in my teens and twenties when I ought to have been living life to the full. Yet I still can’t entirely wish it away. For example, I have weathered some major life crises such as divorce, major relocation, and living in debt, with surprising resilience. It’s common for people to feel that divorce is the worst thing that has ever happened to them, and of course I won’t deny that it was tough. But was it as tough as the pain I’d already lived through in my depressions? No way. Something about surviving acute lows had given me coping skills I didn’t know I had. And depression has definitely given me a better developed sense of empathy, which I have made use of working in health and social care. When my son became unwell with anxiety and panic attacks after changing school, I was able to draw on my own past to help him to understand and get through the experience. Later he told me that he had found me very supportive and understanding in what was a time of great difficulty, and that meant a great deal to me. It was really hard, talking him through panic attacks and suicidal feelings, breath by breath, thought by thought, but at the same time I knew that no-one else in the family had the lived experience needed to do that.
Yet while I feel that bipolar is something I am, I respond to its more obvious manifestations as if it’s something I have, making appointments with clinicians and asking them to help me medicate it into submission. It’s probably fair to say I want things both ways: I don’t want to have my career and relationships damaged, but nor do I want to be medicated out of those parts of bipolar which I feel are intrinsic to my personality. Shortly after diagnosis, I bought Tom Wootton’s second book, Bipolar In Order. At the time, I saw my condition as entirely negative, and I was not at all ready to hear Tom’s message about seeing bipolar as something we should embrace, rather than something we should try to eradicate. Maybe I am now.
A final word: when accessing the crisis team a few months ago, part of my agitated state was a preoccupation with the “am/have” question. In the car on the way to the hospital, I looked over at my partner and asked him, “Would you say bipolar is something I am, or something I have?” He stared back me as if for the first time he thought I was truly detached from reality. “I think it’s something you suffer from.”