When we’re dating or looking to get married, we all come up with a list of qualities we want in our potential significant other. You have to have someone that’s funny, obviously. Intelligence is probably somewhere in the mix. A love of literature, especially science fiction and fantasy; Dune and Ender’s Game, what’s up? Music is a must. Definitely movies. A healthy obsession with BBC police procedurals is a nice little cherry. If you disagree with this list, you and I can explore where you took a wrong turn in your life. Kidding.
Anyhow, I had one important quality that was on my “must have” list: If in the event that I couldn’t, can I trust my significant other to make medical and psychiatric decisions on my behalf? I was asking that question when I was 27. I think for most people, that’s a weird quality to have up there. But if you want to survive and thrive as an individual with bipolar disorder, you’re going to have to incorporate a lot of values and habits that a lot of people won’t really understand.
In a very practical, concrete sense, you need someone close, someone that you can depend on to keep your head straight when you can’t. And you know, not a lot of people can be that person. It’s not an easy job and typically, when they signed up for it, neither of you knew what that job would inevitably entail. Dating an individual with bipolar disorder can be somewhat of a rollercoaster—more or less intense depending on whether they have Type I or II (good luck with Type I folks—sorry babe).
Me and the wife did long distance for about four years. I lived in Davis, CA and she lived in Orange County. That’s about 500 miles. During that time, I drove that distance a little under 100 times. I took the Vietnamese bus maybe another 15 times? Hello to all you “Paris by Night” fans. I went through three cars during that period. Sometimes I would drive down just to have breakfast with her. I did it enough times to see my wife about every two weeks. And how did I manage five-hour drives in the middle of the night? Hypomania. Hypomania is a perk of bipolar disorder right up until it becomes full blown psychosis.
The other side of this story is that during the same time, I almost failed out of UC Davis altogether. I earned three Cs my first semester, then I failed four classes my second semester. I don’t think people really know that I was really, really close to dropping out of college. I also had a bit of a drinking problem at the time, but that’s neither here nor there (though it is). When I confessed this to my wife, she panicked a little, but got my head straight and taught me how to get through school. She tutored me on writing (though I did inherit her dependence on the “em dash”), how to pace myself, research, use a calendar and just how to generally get my shit together. I’d have been fucked without her.
Adding to that, me and those like me, we can’t always trust our minds, the things we do, or the decisions that we make. There are certain times when everything is up in the air and you just can’t make sense of the world anymore; too many moving parts. When this happens, and it happens often, you have to look to the person that’s closest to you. You have to listen to that person, trust their assessment of the situation, and in a symbolic way, give your confusion, anger, and fear to them so they can hold it for you until you get better. In this vein, my wife has had to speak to my doctors, drag me to bed, and decide when to throw in the towel. When you’re hypomanic with a to-do list the length of your arm, it’s very difficult to listen to your significant other when they try to drag you from your desk and make you sleep. But if you want to survive the disorder, you have to have the discipline and trust to get up and follow them.
To drive it home a little further, in a study conducted on bipolar suicide characteristics, researchers were able to identify six major subgroups of individuals with bipolar disorder who successfully completed suicide. One major subgroup was comprised of mostly middle-aged, unmarried men living alone. Interestingly enough, these individuals had no prior suicide attempts; for some reason, they just decided to go for it. Another subgroup consisted of older females, also living alone. Here, researchers could not identify any specific environmental stressors. One might posit that loneliness—or even simply being alone—places older individuals at risk for suicide. I would also argue that loneliness for this population is complex, because in many ways they are existentially alone. For those with bipolar disorder, meaning and purpose are of utmost importance. And one cannot really achieve either of those things in isolation, especially when they’re estranged from themselves. These relationships are the lifeline of living a fruitful life in the face of this illness.
Unfortunately, most basic counseling textbooks never talk about purpose and meaning when it comes to bipolar treatment goals. In Castonguay and Oltmans’ text on psychopathology, the following is a list of treatment approaches for bipolar disorder. First, increase motivation for medication adherence by educating patient’s on the role of mood stabilizers. Second, increase treatment engagement by discussing the meaning and hardships associated with the illness, as well as teaching strategies to enhance regular medication regimens, including techniques to prevent forgetfulness. Third, reduce substance abuse. Fourth, create treatment contracts. Fifth, teach sleep hygiene. Sixth, improve interpersonal skills. And seventh—this is the one that always pisses me off—diminish engagement in goal pursuit. That’s it. That’s all. There’s nothing in there about shaping a cohesive identity, or figuring out who you really are. Most outlines are empty of goals like that.
Drawing on symbolic interactionist theory, identity, how we perceive or come to define ourselves, is socially constructed, developed through our interactions with others. Simply said, we define ourselves through relationships; there is no “I” when we live in the absence of others. Bipolar disorder, especially right after diagnosis, is a marked “biographical disruption”; it alters your identity in more than few ways. First, because of the stigma, some hide this very significant part of their lives, which in turn, limits their ability to fully connect with others. If you hide the disorder completely, you end up living half a life. To hide it completely is to kill a part of yourself. Second, it imposes an “illness identity”. Society, old friends, and sometimes family, no longer look at you the same. They might pathologize you, maybe even fear you. They might question your decisions or attack your judgement. They will call you crazy and discount what you say. And if you somehow change in a direction that imbalances a relationship, there will be some suffering involved.
So, stigma breeds fear of being found out, which exposes someone to the danger of losing their personal identity. The threat of discovery can make an individual with bipolar disorder a bit paranoid, suspicious, and hypervigilant. I have often taken the time to look over everything I’ve said during a party, dinner gathering, or class. I parse it out and check it against how others reacted. If you do that enough, you get slammed with anxiety—it sucks the will out of you. And when the burden becomes too much, you end up avoiding people and hiding. And when you get to this point, you’re in danger.
But to thicken the dilemma, those with bipolar disorder don’t typically live with just a single stigma. Studies have found that 60% to 80% of those with bipolar disorder have experienced childhood trauma—physical, emotional, and sexual. Sexual abuse, which is notoriously underreported, is a significant stigma. Furthermore, those with bipolar disorder have increased rates of panic disorder (62.5%), social anxiety (47.2%), and PTSD (38.8%), all of which are also stigmatized. Then you have attempted suicides occurring at a rate of 25% to 50%–another stigma. And to exacerbate all of this are the side-effects of medication; medication might “out” you before your actual symptoms. Here, you have to be aware of tremors, hide sedation, and make up a slew of reasons for why your vision might suck, why you can’t drive, or have explosive diarrhea.
Take a look at the profile for a second. A lot of individuals count a majority of what I listed above as part of their everyday life. For the person who lives alone or hides themselves from the world, that is a lot of shit to be ashamed about. That is a lot to hold in secret. That is a lot to carry on your own. I do not believe that there is an individual in the world that can contain all of that. And to keep it a secret? That’s a prison sentence. To keep it a secret means that you relinquish your ability to define yourself. If you end up giving yourself over to the world, you become a shell. And I think if you do it long enough, you will lose the battle.
So please, heed this advice and let go of the shame. Find meaning. Find purpose. Lean in to what you love, and lean in to those who love you as you are. It’s in that relationship, where you share who you are and the things that you struggle with, that you will find out just who you are. And just as importantly, you’ll find out who you are to other people. Some might see our disorder as some transient invader that comes to fuck shit up. But you know, it isn’t some invader. It is an essential part of who we are, and we can’t move through life denying or hiding that fact. It must be incorporated into who you are as a person. And these aren’t easy things. It’s scary because it opens us up to rejection on the basis of something we cannot change.
As for the stigma, sonuvabitch does it piss me off. It is so damaging. And for what? Prejudice. Bigotry. Face. Pride. To pretend our lives are perfect white. For nothing. As if there’s no beauty in hardship and struggle and tragedy. We ask victims to keep quiet and to move on, and then punish them if they don’t. These sentiments can be death for those like myself. And God, stigma for those who fight things such as this? I have the utmost respect for those who overcome the illness and make it the end, happy and fulfilled. There ain’t nobody stronger, wiser, or more tenacious. So, humbly and with a good amount of trepidation, I won’t shy away from the harder parts of my life, especially as they relate to the present. I won’t sugarcoat it. And why? Because I’m convicted and compelled to do so. Because I’m pissed at myself for locking up a huge part of who I am for such a long time.
I’m not brave, as some have commented. This isn’t courage. Sharing sucks. Every time I write, I expect to be blasted, by some stranger or by someone close. This has not always been a positive experience. It’s torn my heart up on more than one occasion. Already I’ve been warmed that this will harm my career and ruin my reputation. I’ve been called reckless and morose. And all of this is said with best intentions, which probably hurts even more. But look, honesty is my ticket to freedom. Slowly but surely, I’m takin things out of my shadow and placing them in the light.
And again, I thank the universe for my wife. Without her, I would have never watched The Wire and 24.