Just when I thought I was going to be fine, they say I'm bipolar

After all I've been through, how am I supposed to keep my chin up now?

Published January 17, 2006 11:27AM (EST)

Dear Cary,

For the past nine months I've been struggling with a medical diagnosis that has turned my world upside-down. My reaction to it is making it difficult for me to carry on living, as some part of me feels that this is a death sentence and that there is no way to live with the ramifications of this huge kick in the gut.

Since the age of 15 I have had tremendous struggles with the ordinary tasks of living. Though I was assessed as well above average in intelligence and was thought to have huge potential, I found school and friendships and life to be ordeals full of pain. My moods swung violently from euphoria to deep depression, and though I saw various psychiatrists, the general feeling was that I wasn't trying hard enough and should be able to pull myself out of these struggles. I drank heavily to try to cope with feelings of self-hate and alienation.

I didn't go to university, but met a man when I was 18, and married him within a year. Though my life was limited in many ways, I did love him deeply, and had two children by him in my early 20s. Though this period of my life was relatively stable, it was blown to pieces in my late 20s by another crisis, in which my moods once more began to careen out of control and I landed in the hospital.

Though I saw many therapists over the years, there was never any agreement on what was wrong with me: major depressive disorder, post-traumatic stress (I grew up in an alcoholic home and was sexually abused, my brother was a schizophrenic who died young, and my aunt committed suicide), and (worst of all) histrionic personality disorder, which implied that my suffering was merely empty theatrics. One doctor even told me, "Go home and behave yourself."

By my mid-30s I was drinking alcoholically, and beginning to sink. At the same time, I had carved out a bit of a niche for myself as a columnist and a book reviewer, and I had written somewhere around 1,000 pieces that had been published. I adored my children, and they were turning out well. I was active in my community, when I could manage it. But psychiatrists did not count these accomplishments at all, and continued to see me as immature and lacking in self-control.

When I was 36, I hit bottom with the alcohol, joined a 12-step program and began to heal my life. There followed 15 years of relative stability -- sober, seeing a psychologist who was much more respectful, and finally writing a novel that was published and very well received. All my dreams seemed to be coming true: I was a grandmother, my book was out, I had an agent who sold my second novel, I had found a way of faith that fit me well, and my husband and I were planning a trip to New Zealand for our 32nd anniversary.

But something strange started to happen. My sleep was gradually getting less and less. My mood went from normal to euphoric, and I began to believe I had special powers. Soon my thoughts began to accelerate. I had been through this a thousand times already, but this time I believed I was on the verge of a powerful God-consciousness that would save not only me, but the entire world.

When the crash came, it was catastrophic, and I landed in the hospital for the first time in 15 years. The shrinks there dusted off my old file, assumed I had experienced no personal growth at all since 1990 (they looked incredulous when I said I was a novelist, and I am sure they did not believe it), and told me once again that I had histrionic personality disorder.

But my general practitioner, who had known me for 14 years, said, "Wait a minute." After an appointment where my speech and thoughts raced incoherently at full tilt, she stopped me and said, "I think you're bipolar." The statement socked me in the gut, but at the same time, strangely enough, it was a huge relief.

Once I got out of the hospital, I found a shrink who actually made sense and seemed to know his stuff. After half an interview, he said, "I have no doubt this is bipolar." He told me that misdiagnosis is often part and parcel of this illness, as the manic phase (which in my case was extremely productive) can often look like high energy and good health. Again, relief and recognition vied with utter shock.

What has happened since is a ferocious battle in myself, a complete inability to accept the fact that I now have a full-blown, full-scale, serious mental illness after 15 years of remission. When I look at my symptoms, I don't know what else it could be, and I don't disagree with the fact of it. I just can't accommodate it. It isn't OK, and I'm not OK for having it. This has triggered the worst self-hate of my entire life. I feel like the family script (fatal mental illness) is coming true in me, as if it's my turn. On all these drugs, I doubt if I will ever write creatively again. It feels as if my life is gone. I never realized I harbored such hate and fear of mental illness, but apparently I do. Every time I even approach the idea of acceptance, which everyone tells me I must, I break out in fury that this could have happened during the best time of my whole life. Most people assume psychiatric catastrophe can only occur during a period of adversity and horrendous stress, but mine didn't. I had never felt better in my whole life, but I came very close to dancing naked on a public street.

My husband keeps saying, "This is what you've had your whole life." No one has known me longer than he has, and he has watched me go through hell and pull myself out of it over and over again. But why am I breaking out in trouble like this, after being well for years and years? Why, why, why? I stayed sober through it all, and 12-step programs always say that "God restores us to sanity."

So what happened? How can this be? God seems like some distant enigma that I can't reach anymore. I can't forgive it, can't get on with real recovery, and I know this rage is going to consume me eventually. In spite of all the good things in my life that I've worked for so hard, in spite of seeing a psychologist who just keeps telling me to treat myself with kindness and respect, I feel totally humiliated and struggle every day with the urge to commit suicide. Though I try not to, I feel in disgrace.

I have made a pact with myself, which for my family's sake I hope I can keep, to postpone killing myself for one year, on the off chance I will be able to accommodate this horror and find that I want to continue. But I am not sure I can keep it. Well-meaning people say things like, "Well, you got better before, didn't you? Just do what you did then." This infuriates me, as how can I "just do what I did before" (the "just" implying it's a piece of cake and I'm not really trying) if I am not the same person? My identity has been blown into vapor, and there is no way to put the pieces back together because there are no pieces. I don't know how to start over again, one more time, and if I do, how long until everything explodes all over again?

If you could try to give me a perspective that goes beyond the platitudes, the "focus on how blessed you are," the "just do what you did before," I would greatly appreciate it.

Bipolar Writer

Dear Bipolar Writer,

You are ill. I can say things and say things and say things but I can't make you well. I wish I could but I can't. All I can do is say hang on for dear life until it passes. It will pass. It passed before. It will pass again.

But what can you hang on to? What have you got? Have you got a will to survive? Have you got a belief that pleasure and sanity will return? I think you probably do. This illness, of course, will cloud your mind. It will distort your thinking. It will place a veil over your memories. It will work on the "you" so that you cannot be sure what is you and what is the disease. It will make you believe that there really isn't anything worth living for. It will make you believe that your life is over.

Your life is not over.

But what good does it do for me to say that? You are the one who must struggle against this thing. The little sayings and truisms of your 12-step program must seem woefully inadequate to that task. And yet ... you must have acquired from your 12-step work a crucial skill for dealing with this new and daunting diagnosis: You know how to coexist with a force against whose power to subvert your thinking you are more or less helpless without outside intervention.

So, strangely enough, I would think a recovered alcoholic is better suited than most to cope with a diagnosis of severe mental illness. While I am not really a fan of literal translation of the 12 steps ("We admitted we were powerless over acne and came to believe that a power greater than ourselves could restore us to lustrous, peachy smooth skin ...") in this matter of insanity it does seem that you must place yourself in the hands of powers greater than yourself and trust that you will be restored to sanity.

You must struggle to maintain in your mind a picture of the world to which you fervently wish to return, knowing all the while that no matter how hard you struggle you are going to slip underwater from time to time into the nightmare from which it will seem there is no escape but you are going to wake up eventually and it is going to be sunny outside and you are going to walk barefoot in the grass wet with chilly spring dew once again before long, and you are going to enjoy many more years of sanity once this thing is over; and it will be over.

You must believe that. There is nothing else worth believing.

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