Bipolar Me

I once suggested to a writer that he should include chemist Clara Immerwahr in his book on notable women. After her education, she had no opportunities to do her own research, as it was the early 1900s. Instead, she helped her husband in his. In 1915, she killed herself because she couldn’t accept the weapons-related research on poison gases her husband was doing. My friend replied that he wanted the women in his book to demonstrate agency.

At the time, I didn’t know what “agency” meant in any context than as an organization or business. Gradually, I learned what else it meant. And I looked it up for an official definition. After giving the definition I expected, I learned that “sense of agency refers to the feeling of control over actions and their consequences.” Clara Immerwahr did not have agency, and she was not included in the book, even though her story was both poignant and important.

While I was at it, I looked up the definition of autonomy. The definition included this: “Autonomy is all about having a choice and a voice. It fulfills an innate need to feel that we are acting of our own volition, allowing us to fully accept the consequences of our actions. It means feeling psychologically free and having the ability to control your life.”

It occurred to me that people with mental illnesses often either lose their agency and autonomy or never have them in the first place. Of course, many (I hesitate to say most) people these days lack agency or autonomy. They feel trapped, unable to control their own lives. How many people are ultimately psychologically free? How many control their own lives? Limited agency and autonomy are all that we seem to get, and limited autonomy strikes me as being like those ads that say a dental treatment is “virtually painless.” When it comes right down to it, that means “not painless.”

But with a brain illness, it becomes much more difficult to achieve agency or autonomy. The illness takes them away. A feeling of control over actions and their consequences? Tell that to someone who has just maxed their credit card on a manic jag. Minimal control of actions and no control of the consequences. Psychologically free and having the ability to control your life? Tell that to the homeless person with schizophrenia.

IMHO, one of the purposes for the mental health “system” ought to be restoring agency and autonomy to the people they serve and then helping them keep it, whenever possible. But that’s too much to expect, I guess. With the little funding for services and the lack of availability of proper care, there’s not much help for the person with SMI who wants to achieve agency or autonomy. In terms of mental health, just as in senior care, agency and autonomy are difficult to attain and maintain. We don’t have the kind of institutionalized care that would take away agency and autonomy completely, but neither do we have the systems in place for supporting those who have a chance at reaching it. It’s one of those Catch-22 situations.

You can’t give someone autonomy. You can only facilitate it. But we’re not even doing that.

In the past, I’ve had difficulties with my blood sugar. If I went more than four hours or so without eating, I got dizzy and weak. Fortunately, It’s not that difficult to arrange to get food within four or five hours. As long as I kept an eye on it, I wasn’t overly bothered. Although once I didn’t eat for about three days and didn’t just get dizzy, my entire body started shaking.

But a good while back, when I was undiagnosed and unmedicated, I had a different relationship with food. When I was manicky (which in my case manifested as anxiety) I didn’t eat much. I got so skinny that I feared my parents would notice when they came to town for my graduation. So I ate bananas and drank milkshakes in hopes of putting a few pounds on.

But when I was depressed, I ate—poorly, but I ate. I had certain go-to depression foods. Sugared cereals. Carbohydrates like mashed potatoes, fries, and other comfort foods. And a peculiar combination of wavy potato chips and cream cheese topped by an M&M. My husband knew to get worried when I asked him to pick up those ingredients.

But back to blood sugar. The interactions between blood sugar and bipolar disorder are complicated because the interactions between the body and the mind are too. Let’s look at some of those interactions.

First, there are medications. It’s well-known that bipolar and other psychotropic medications can cause weight gain. And in turn, overweight can lead to diabetes. I have indeed gained weight—a lot of it, in fact. (I still prefer fat to misery.) I haven’t acquired diabetes, but I no longer get the low blood sugar weakies.

Then, there’s stress. Bipolar disorder can be affected by stress, of course. Stress can exacerbate the symptoms. The symptoms can cause stress. It can be hard to break the cycle. But stress releases the hormones cortisol and adrenaline into the body, and those substances can cause blood sugar to rise. Poor quality sleep and irregular sleep patterns also affect your body’s chemicals in ways that can affect blood sugar.

Also, as I’ve learned, bipolar can alter your eating habits, causing your blood sugar to behave like a yo-yo. It can also affect your ability to care for yourself in other ways, such as not having the wherewithal to exercise. These lifestyle changes can also make your blood sugar fluctuate.

Also, though this isn’t well understood, there may be genetic factors that are associated with both bipolar disorder and high or low glucose levels. As always, more research is needed.

So, what does this all mean? First, that you should be aware of your blood sugar fluctuations. Maybe track how they correspond to your moods and your lifestyle factors. I’m not saying that you need to get a glucose meter (though if you have one, that’s great). Just know that the two conditions can interact, and the more you know about how they affect you personally, the better off you’ll be. You may be able to make changes in your diet, exercise level, and sleep habits that will make a difference.

Stress reduction is also something that will be beneficial for both conditions. Your therapist may have recommended stress reduction techniques such as meditation or mindfulness (among others), and you may find that these help, too. If, like me, you have high levels of anxiety, your family doctor or psychiatrist may be able to prescribe you an anti-anxiety med that could also help regulate your sleep patterns.

Watching your blood glucose won’t hurt and might help you deal with your bipolar or other disorders. It seems to me that it’s worth a try.