This is bipolar.
It was a warm February or March day (I can’t remember now) in 2010, and the sun was beating down on me through my windshield as I sat crying in my car outside my doctor’s office, clutching the prescription she had just handed me. All I could hear, echoing in my brain were her words, “I think you might be bipolar.”
When I was 14, I started going to therapy. My parents had a messy split when I was 11, followed by a reconciliation. My mum offered to make therapy available if we needed it, and I took the opportunity to do so. Most of that period was me, me working through my anger surrounding family life, but it solidified my desire to be able to talk to someone as I went through difficult periods.
When I was 18, I was diagnosed with severe depression, severe anxiety, and elevated symptoms of obsessive compulsive disorder. I had always known I was different. But it was in an educational psychology class my first year of college as we were going over symptoms of anxiety disorders for children that something clicked for me. I left class, met my mum, and said, “I think something is wrong with me.”
After my first year of college, I left Phoenix (the first time), returning to my hometown in an effort to stabilize myself after realizing my brain was working against me. Through my diagnosis that fall, I was prescribed an anti-depressant, which started to work. I was beginning to feel less anxious and more balanced. I was seeing a new therapist, and trying to make sense of what was going on in my head.
Here is where I need to issue a disclaimer: I am a huge champion of therapy and medication used in conjunction to treat mental health issues. None of my experiences have changed that. I do believe professionals need to be held to a high standard when it comes to their practices, especially when patients don’t know how to or are not able to advocate for themselves.
I was seeing a psychologist and a psychiatrist in the same building as part of a practice that worked in tandem: talk it out, then prescribe. It was going well at first and then everything began to fall apart. My psychiatrist increased my medication dosage to a level he described as almost the highest he could go. My psychologist started falling asleep when I was talking to her. At now 19, anxious and depressed with no idea how to handle any of this, I felt the bottom dropping out. I had transferred to a college back home, but it was at this point I started losing interest in school, in everything. My medication levels were so high that I stopped feeling; I could be cruel with little repercussions because I wasn’t capable of feeling bad. I slept all the time. I had taken a job at the mall, and that was the only thing I had interest in because it kept me occupied and I didn’t have to think about how awful everything was. In the coming months, I would drop out of college, lose my health insurance (pre-Affordable Care Act; I had to be in school to be on my mum’s insurance), and abandon therapy and medication.
The next parts of my journey are spotty as my memory isn’t very clear nor am I sure was I processing my life. I was in and out of college, never feeling quite capable of going to class. This was new to me, having been a high honors student in high school, preferring learning to most everything else. Around the spring of 2008, I had health insurance again thanks to trying school again and my primary care physician had recommended a new therapist to me. I was dragging my feet scheduling an appointment because the therapist was a man and I wasn’t comfortable with the idea of discussing my issues with a guy. Eventually I made the appointment, managed to convince myself to go, and ultimately had my life changed forever.
Sitting in a beige room with tattered magazines of every lifestyle magazine possible, I sat there waiting to be called back, clutching the check my mum had written me to cover my co-pay. There was no receptionist so I wasn’t sure I was even in the right place, causing my anxiety to bubble up even more. After what felt like an eternity, an older man with bright white hair, small wire-rimmed glasses, and a gentle smile appeared out of the hallway.
“Jessica? Can I get you a cup of tea?”
Every appointment started that way. My new psychologist had his office set up in a way that looked like my grandparents’ living room. Every week or two, I would slump into an oversized, plush chair, gripping my tea, and pour my heart out to my doctor. He had a way of making me comfortable that allowed me to say what I was truly feeling, and I knew he was listening because he would ask probing questions or clarify points I was making as the words came rushing out of my mouth. More importantly, he understood my mind and put into words things I had subconsciously knew, but couldn’t vocalize. The key here is that he utilized cognitive behavioral therapy, leading me to start understanding my brain and my behaviors more. Every session, he would allow me to talk for around 40 minutes, but the last 20 were reserved for him to discuss action plans and exercises to minimize my anxiety and be able to face my obstacles in a healthier manner.
Alas, I stuck with therapy as long as I could, but ultimately couldn’t afford to keep going, so I stopped. For a while, I was doing well, equipped with the tools and skills my doctor had given me. I had even started thinking about going back to school, which I started again in the spring of 2010, leading me back to the doctor.
Honestly, I made the appointment with my PCP because I was having trouble focusing with my brain constantly buzzing, and I thought I needed Adderall. We began talking through my symptoms and what I was feeling, and I just started crying out of nowhere. I had talked about my symptoms to so many doctors before, I couldn’t fathom why I was crying about it as it had become like a script for me (“I was diagnosed with severe anxiety and depression, symptoms of OCD, my brain doesn’t stop and I can’t focus, I am really sad and have trouble getting out of bed…”) After a long pause, she looked at me and said, “I think you might be bipolar. Will you take this questionnaire? Bipolar is often misdiagnosed in teen girls as just depression and additional characteristics often don't start becoming prevalent until your early 20s.” Shaking, I filled out the sheet of paper she gave me and handed it back. After reviewing my answers, she turned to me and said, “I believe you are bipolar. I would like to start you on a low-dose SSRI and refer you to a psychiatrist for a more complete course of action.”
To say I was shocked may have been the understatement of the century. I felt crazy, but was I that crazy? I was overwhelmed. Nonetheless, I started my medication and made an appointment with the psychiatrist. Here, I must interject again that I am absolutely for medication and therapy. I will also say this next bit can be triggering (CW: mental health, suicidal ideation).
I met with the psychiatrist who, after 45 minutes of doing my intake, decided I was not bipolar and that she wanted to drastically increase the dosage of the SSRI I was on. Feeling very confused, I ultimately decided to follow her orders and filled the prescription for the new, higher levels. Now, increasing an anti-depressant in a person who is exhibiting bipolar traits can send them into a tail spin. This is the ugly part.
I was living at my mum’s at the time, attempting to figure out my next move. I had moved back from Philadelphia about six months prior and still had no idea where I wanted to be or what I wanted to do. She was away for the week, visiting Phoenix, so I was left to tend to the cats and watch tv. I started taking the prescription for the high dose and almost immediately knew something was wrong after a few doses. My body began to ache and throb. My brain was spiraling out of control and I couldn’t stop it. I was writhing on the couch, in pain and so uncomfortable in my own body while a Law & Order: SVU marathon blared in the background. Most of my memories of the time are the pain and how dark everything was in my mind. I also remember that it all got so bad that for the first time in my life I had thoughts that scared me: I could just end it and it would be over. I want to die. I should just kill myself.
I honestly don’t remember how I managed it but I was able to call my mum, bawling. I can still hear her, Stop taking the medication NOW. My boyfriend at the time didn’t live in the same town, but stayed on the phone with me or texted me when I couldn't talk, making sure I didn’t harm myself. He later told me he was scaring everyone at his house because he just kept pacing outside, smoking cigarettes, trying to help from afar but feeling helpless. Between the two of them, they stopped me from harming myself, and supported me through the worst of it and until the medication was out of my system.
That was over eight years ago, and I haven’t seen a therapist or taken a pill since. Instead, I ran to the southwest and started over again. While there, I went back to school and finished my bachelor’s degree. In school, I took a class called “Finding Purpose” where we practiced mindful meditation and determined our values. (I initially made fun of this class, but it turned out to be the most important class I’ve ever taken. It was developed to provide artists and designers the skills to determine their beliefs and values while knowing their own personalities to provide direction post-graduation. Everyone should take this class.) I finished school, and six months after, moved to Pittsburgh and started over yet again, which I maintain has been one of my best decisions.
However, in the past few years, I’ve had to face some obstacles: family illnesses, revelations of trauma from those close to me, and six deaths of friends and family. This is not to imply that no one else faces challenges in their life, but rather to illustrate that these have exacerbated my bipolar disorder again. For nearly a decade, I’ve been able to maintain it with skills I learned from a great psychologist and from meditation learned from a kind professor. Unfortunately, now I am back in a place where I need to consider different measures. This spring brought more frequent episodes of hypomania followed by crushing depressive episodes and a few panic attacks thrown in for good measure.
Via the National Institute of Mental Health; https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
But what does that look like? Bipolar II disorder (how it was presented to me in my nebulous diagnosis) presents itself differently than Bipolar I, masquerading as unipolar depression most of the time. However, there are those spikes in mood, feeling off the charts great. These episodes are happening more regularly, and I have days when I’m “up” — lots of energy, personable, productive, overly social. The darker side of these episodes are the distraction, irritability, touchiness, and anger that begin to present themselves after a few days or so. While not full-blown mania, it does feel like I’m in hyperdrive from my thoughts to my actions, taking on many projects, talking quickly, being excited about basically everything, not sleeping, and having thoughts happening quickly and incessantly. Everything feels like it’s pulsating and I want to crawl out of my skin at the height of it all. Then the converse happens and I crash into a depressive episode — lots of sleeping, feelings of suffocation, social withdrawal, sluggish and foggy brain.
After so many years of feeling fine and balanced, it’s hard to slip back into this fluctuation between highs and lows. So, after a long hiatus, I have an appointment scheduled to talk to my PCP about counseling options. I’m still not ready to explore medication again, but I feel more equipped to advocate for myself if that time comes. This is all scary and overwhelming despite having gone through this all before, but I know it’s necessary to take these steps to put myself back on track.
My goal of this post is to be more open and honest about what bipolar disorder is. This isn’t an academic examination of the diagnosis, but rather how it impacts me personally in hopes that someone else can relate and maybe not feel so alone. Mental health shouldn’t be secretive and shrouded in stigma. I am not prevented from living a healthy, functional life; rather I face some unique challenges that have taught me to work differently. Selfishly, this is helping me process what I’m going through and will hopefully hold me accountable to follow through with treatment. Mental health needs to be prioritized in more ways than one, and maybe be talking about it more openly, we can start pushing forward in improving access to treatment and healthcare. In the meantime, I am focusing on self-care, being aware of my limitations, and trying not to feel guilty of where I'm at mentally. I think we all could use that.
National Institute of Mental Health: Bipolar Disorder
Photos: various Polaroids taken around ages 21 & 22