Loving The Prodigal Self
I just finished watching Stephen Fry’s short BBC series “The Secret Life of the Manic Depressive“. In this series he engages with the questions that many of us (I presume) who have been diagnosed with any sort of mental illness struggle with:
- Is my diagnosis accurate?
- Will my condition get better or worse or stay the same?
- Should I consider medication?
And that big, important and vexing question:
- What does this mean about who I am; if I treat what is deemed a disease, will I lose my Self?
I have thought about these questions many times over the last 6 years. I was first diagnosed with bipolar in 2005, though I have had depression and other mental health issues since I was a very young child. I have been to therapy and treatment centers and I have been up and down the entire gamut from doctors who seem to hate their patients to doctors who are brilliant and helpful. I have read and researched and talked and learned and pretty much been there done that. I have tried dozens of medication cocktails and suffered innumerable and unbearable side effects. I have “self medicated” with recreational drugs (oddly enough alcohol never really caught on for me) and I have toughed it out on my own with diet and exercise. I have been in intense therapy with medication and talking and been on meds alone. Being put on the wrong medication (for depression only) seems to be the key to my worst manic episode. My experience with medication and treatment is not all rosy to say the least.
Okay, so I have experience, you get that…. here’s where I stand on the big question: “If I take medication, will I still be myself ?” (What follows assumes that medication is an option for a person with bipolar, there are plenty of people who either don’t have the choice or don’t know they do. Here’s a place to start to look for resources for people who don’t have insurance coverage or need low cost care)
Let’s say I tell you that I am in love with someone who is often wonderful and loving and creative. They are kind to me and shower me with gifts and praise. But… I say this somewhat haltingly, sometimes they start to call me names. Sometimes they will say such awful things to me I don’t even know what to think anymore. They will strip me bare to my most vulnerable parts and then poke at those wounds day after day. They hurt my feelings so much I can barely face the world and I don’t understand what I did wrong.
They have even tried to kill me… more than once. They encourage me to engage in risky behavior like binge drinking and drugs. Sometimes they suggest I might cut myself or hurt myself physically other times they just pressure me into doing things that normally I would find shameful or immoral. I never really know who I am going to be facing when I get ready to see them.
These bad times aren’t all the time, I swear and when we are happy together oh my god, we are so happy. There is nothing like the joy I feel when I am with them when they are being good to me. Nothing makes me feel so alive and so powerful and so blissfully out of control. They bring out the artist in me, the clown, the bold and sexy woman that I just don’t think I could be without them. It’s worth the lows to have the highs, right? I know I won’t ever find anyone who can make me so happy and… okay, I know I have gone to jail or nearly died or ruined a friendship or a marriage or two… I was in the hospital that one time and I should have been those other times but I didn’t end up dying and I am just not me without them.
Would anyone in their right mind suggest staying with a partner like that? Bipolar is a partner like that in case you didn’t get hit multiple times by the sledgehammer my metaphor was wielding. BiPolar is a Self in your head that WANTS TO KILL YOU:
“According to Kay Redfield Jamison, one of the leading experts in the field of bipolar disorder, ‘Suicide, which is both a stereotypic yet highly individualized act, is a common endpoint for many patients with severe psychiatric illness. The mood disorders (depression and bipolar manic-depression) are by far the most common psychiatric conditions associated with suicide. At least 25% to 50% of patients with bipolar disorder also attempt suicide at least once.’
Although many people with bipolar disorder who attempt suicide never actually complete it, the annual average suicide rate is 10 to more than 20 times that in the general population.”
While the experts currently don’t agree on the exact risk percentage that people with Bipolar have, many of us have more than two or three direct attempts under our belts and countless indirect behaviors that basically say “I don’t want to die but if it happens… meh”. BiPolar is a Self inside of us that has the goal of dominance and destruction. Dominate our behavior, destroy our lives. I compartmentalize Bipolar as some sort of second self because I refuse to submit to the theory that all of my creative energy comes from hypomania or mania. I reject the hypothesis that I wouldn’t be “me” without it insofar as that hypothesis leads to refusing medical intervention. And furthermore, even if I am NOT myself with medication… is the self I am without it (assuming other interventions have failed) a self I really want to be?
I don’t think that medication is right for everyone and I certainly don’t think it should be step one of a treatment plan. Anyone who realizes that they have something in their behavior and psyche that interferes with their ability to “live, love, work and play” would be best served in my opinion by starting with journaling and either talk therapy, group therapy or one on one with a close confidant depending on their situation and severity.
Medication is not an easy thing to take, especially for bipolar. It isn’t as simple as deciding which drug commercial you think is most inspirational and then running to your GP to fill a ‘script. Bipolar is notoriously difficult to medicate simply because it is so particular to an individual. Think about it – your mood swings all over the place, do you think it is so simple for a chemical to adjust to that much chaos? In addition, many of us find that medications that used to work stop working and adjustments are needed. We have to have uppers for the depression but not *too* up and downers for the highs but not *too* down and then diet and supplements to deal with the effects the meds have on our bodies. It’s not pretty. I was told by one psychiatrist that many of her colleagues wouldn’t even treat bipolar patients as it was too complex to try to match medicine to prescription coverages and adjust constantly within those constraints.
It isn’t just popping a pill and Bingo! All better!
All of that aside, let me come back to that one little fact… Bipolar WANTS TO KILL YOU. It doesn’t care if it kills you slowly through risky behavior and self neglect or swiftly through suicide. It wants to isolate you from your support structures and your places of refuge. It wants to eat your Self alive and leave only the disease.
Think that sounds dramatic? Maybe, but the times that people with Bipolar are under its control, they are under its control. When the chemical storm subsides there is just as much wreckage in their lives as there is after a rainstorm or a tornado. Sure, when the BiPolar roulette comes up Hypomania then life is brilliant and productive and sexy and thrilling. When it comes up Mania it is euphoric and unlike anything anyone else experiences. But what goes up must come down and it seems to me from my reading that most of us have more down than up but both down and up can be incredibly dangerous and damaging.
So yeah, I think that giving medication a chance after trying other options or in tandem with other options makes a lot of sense. And here’s the funny part…
When I was on my full cocktail of meds including some meds specifically for bipolar, it was as if I was more my Self than I had been since before puberty. There was a muck – a stain – a barrier that had been lifted and I could react with reasonable emotion to outside stimuli. That meant being happy when something good happened and being sad when something bad happened but not being distraught when I had it all or manic when the world was falling down around my ears. I was more creative than I had been because I could *control* the flow of my creativity. Say what you want about hypomania or mania but the one thing it isn’t is controllable. I could actually harness that bucking beast and make it work for me!
The truth is, again in my opinion, that there are two things at play when people with BiPolar specifically refuse to even try medication. The first is that the diseased self wants to live. Again, it is a metaphor of sorts to section it off that way but it makes sense to me. Your brain adjusts to patterns and as chaotic as bipolar seems, it can be counted on once you discover your pattern. Moving away from the cycles is scary and foreign so we come up with excuses to keep them.
The second is that BiPolar people are generally compulsive, addictive sorts of people and I will be perfectly truthful and say there is no better drug than the one your own brain can feed you. We are constantly chasing the dragon of those highs – hoping for them even when we know that they can spiral out of control and we might not even know it. Who the hell would want to give up a legal, free drug that makes you feel amazing while you are exceptionally productive, happy and creative? It’s a hard thing to let slip away. And dammit, we have suffered so much at the hands of the depression side, don’t we deserve our nature given highs?
That’s where I come back to the mythical romantic partner in my head. I might love them more than I have loved anyone and I might have more fun and better sex and feel more amazing when I am with them than with anyone else, but in order to get all that I have to let them tear me down, hurt me, encourage me to hurt myself and oh yeah… every once in awhile they are going to try to kill me.
In the BBC special, Stephen Fry interviewed several people but the one that got to me was Gene Hackman. He was on medication and likened it to “living in letterbox.” When the picture changed to letterbox I understood what he meant — the very top of the screen and the very bottom were no longer part of his life but the center expanded outwards and he still took up most of the screen. That doesn’t seem so bad when you put it that way.
Giving up the edges of your highs and lows isn’t an easy decision and it might not be the right decision for everyone but I can’t see giving up on even trying medication when you are still having symptoms that interfere with your life because you are scared of not being yourself.
If you’ve gotten this far, I’d like to add one more bit of my own experience to the mix. The stigma surrounding mental health is well established but there are also special concerns about BiPolar meds that I keep seeing and hearing about. Once again I will admit this is only based on personal experience and research but it I wouldn’t be shocked to find plenty of evidence to support my assertions that:
- If a medication makes you feel like a “Zombie” it isn’t the right dose or the right medication for you. Use something else. (Except in emergency interventions when sedation may be needed)
- Lithium is a helluva drug but if you don’t take it for very long you will NOT be stuck taking it forever. If you can tolerate it without severe side effects than have at it. If not, change doses or take another medication. Lithium is not the be all end all of bipolar meds.
- If you have a doctor that is firm that the ONLY medications for Bipolar are A,B or C and you can’t tolerate the side effects, it’s time to get a new doctor and try new meds and new doses.
- Getting the right cocktail is a shitty process. It’s uncomfortable and expensive and awful, but if you have a doc who will work with you and will remind you that YOU are the one who decides what side effects are “reasonable”, you can find the right meds and doses for you. You just have to be patient and you have to be brave.
- Sometimes you don’t need to be on medication or you don’t need your full arsenal. There will be times where you find you need more chemical help than others. Diet and exercise, behavioral therapies and talking can take up the slack for some meds when you are not in a crisis. Your meds are no more static than your moods, stuff can change.
I don’t know who will read this but I do sincerely hope that it will be of use to someone. I am so tired of people coming to the conclusion that they won’t take medication because they will lose their “self”. The self they are talking about losing isn’t very nice to them if they really think about it. I do think going without medication is a perfectly reasonable choice for someone to make but it seems to me it should be made after trying medication if after trying all other options, symptoms are still inhibiting your ability to live, love, work and play. At least know how medication effects you before you say it isn’t for you.