Bipolar 2 From Inside and Out

Posts tagged ‘mental health’

Mental Health Privilege

Vectorarte / Adobestock.com

These days we hear a lot about privilege – class privilege, white privilege, first-world privilege, male privilege, and, I’m sure, many more. The idea is that people who have privilege don’t have problems that other people deal with every day and. In fact, they don’t usually realize that they have this privilege and benefit from it.

I know that I am privileged in many ways. I am white and heterosexual. I have a house, a husband, and work I can do. I have an Ivy League education and grew up in the suburbs, the child of loving parents who never divorced.

But what I don’t have is mental health privilege. I have bipolar disorder.

When a person has mental health privilege, they don’t have to take multiple medications just to keep their brain functioning in something like a normal manner. You won’t get pill-shamed for the meds you take or have random people suggest your problems will all be solved with prayer, yoga, apple cider vinegar, or acupuncture.

(I do recognize that there are many people who take meds for a variety of disorders, including life-threatening ones. I don’t mean to discount their struggles. Physical health privilege and ableist privilege also exist.)

When you have mental health privilege, you don’t have to question whether or when you should inform a boss, a potential employer, or a friend or romantic partner that you have a mental disorder. You don’t have to fear that that one fact will make it more unlikely that you can achieve a stable work situation (or any work situation) or a stable relationship.

When you have mental health privilege, you don’t have to try to find a therapist who specializes in your problem and can actually help you. You don’t have to repeat your whole psychiatric history every time your therapist gets another job, causing you to start all over with a new therapist. You also don’t have to ask your primary care physician, who may or may not know much about psychotropic meds, to prescribe for you until you find a psychiatrist or when one isn’t even available to you.

When you have mental health privilege, you don’t worry that people will avoid you because you act “peculiar,” miss appointments and dates, or can’t handle crowds or even family gatherings. 

When you have mental health privilege, you don’t have to fear that you may have to stay for a while in a mental ward or have treatments like ECT.

When you have mental health privilege, you won’t get shot by a police officer just because you have a meltdown or a really bad day or a psychotic break.

Of course, the privileges I do have protect me some. Realistically, there is less chance that I will be killed by a police officer than would a person of color. In fact, my race and income make it easier for me to access mental health care.

The Journal of Psychosocial Nursing and Mental Health Services, in its July 3, 2017 editorial, makes clear that mental health privilege affects not only people who have mental disorders, but also the people who care for them.  The piece, written by Mona Shattell, PhD, RN, FAAN and Paula J. Brown, MBA, points out, “More than 70% of all health care providers in the United States are White (U.S. Census Bureau, 2017), and many, if not most, have unconscious (or conscious) biases (Institute of Medicine, 2003).” Their level of privilege may interfere with their treatment of their clients. The authors of the editorial encourage those with privilege to use it to help others.

Racial privilege is particularly problematic when considering mental health providers and their clients. NAMI Illinois “reported studies found that ‘black professionals make up only 2.6% of mental health clinicians in the United States, which is low considering that approximately 20% of black Americans seek mental health specialty treatment within a 12-month period.'” “While access to culturally diverse providers is low, the cost of mental health treatment remains high,” they add, “which serves as an additional impediment to bridging the gap between the onset of symptoms and accessing professional care.”

Education about mental health privilege may or may not help. Many people pooh-pooh the idea of any kind of privilege and bridle at the idea that they themselves have privilege by virtue of their health, sex, economic status, or other attributes. Some people’s eyes can be opened. (My husband didn’t recognize male privilege until I pointed out that no one suggested he change his name when we married or that we were “shacked up” because he didn’t.)

It’s understandable in a way.  People have a hard time envisioning that they themselves might ever be mentally ill or poor or homeless or denied work or discriminated against in any number of ways.

But with mental health privilege, it’s even more difficult to get people to understand. Until a close friend or family member faces mental or emotional difficulties – suffers from PTSD, experiences major depression, develops schizophrenia – people will not usually have the opportunity to realize the mental health privilege they have. And they may not even then.

As with any kind of privilege or stigma, if there is to be any improvement, people need to be educated. It’s not easy to open their eyes. But doing so can make a difference in the lives of people who do not share that privilege.

Yes, It Was That Bad

By patpitchaya/adobestock.com

There’s a tendency, once you’ve started to heal from the wounds that mental illness has left you with, to forget how bad it really was at the time. It’s not that time heals all wounds. It’s just that the memories fade as they flow backward into the past. You find yourself asking, was I really that miserable? That irrational? That out of control? Once therapy and medication – or whatever works for you – have gotten you past the crisis stage, it gets harder to remember what it all felt like at the time.

Nor do we want to. Going through an episode of serious mental illness is hard enough when you do it once. Reliving it is devoutly to be avoided, if possible.

Still, the memories get a little fuzzy around the edges. Now that you are mentally healthier, you know that you would never tolerate the kind of treatment you used to, or be so self-destructive, or put yourself down so thoroughly. The times when you did those things, when you felt those ways, seem in some sense unreal.

I think that’s one reason that some people go off their meds. It’s not just that they feel better or think that they’re cured. It’s that on some level they can’t remember how bad it really was back then. So why should they need psychotropics?

Well, I’m here to tell you that, yes, it’s much better now, but yes, it was that bad back then. You may not remember the weeping and wailing and total despair. You may not remember that you were immobilized for months at a time. You may not recollect pushing away people that were trying to help you. But all that happened.

Perhaps you don’t recall what it was that led you to consider self-harm or suicide. You wouldn’t think that way now, of course – you’re so much more stable. Perhaps you think to yourself that an abusive partner wasn’t really all that bad. After all, you got away from him/her/them. It was survivable, so it must have been not that big a deal.

But it was that big a deal. Denying the experiences you’ve had and minimizing their effects on you make it harder to see the long way you’ve come. It’s hard for me to remember now the major bipolar depressive episode that lasted for literally years, when I wasn’t able to work, or write, or read, or be there for my husband or even myself. But it happened, and I can’t deny it. I’d be lying to myself if I tried.

I’m not recommending that you wallow in the memories of the horrible times. I’d rather think about it as keeping little bits of them in a box on a shelf. Every now and then, on a day when you feel particularly strong, you open the lid and peek in. It may be shocking to realize how bad off you were, but a positive relief when you consider how far you’ve come. As the saying goes, the bad times make the good seem so much better.

Bad and good, your experiences have made you what you are today. Denying or minimizing the bad makes it seem like your journey was less long and hard than you know it was. In a way, mental illness is the yardstick by which we can measure mental health. Moving onward and upward are important, but so is being realistic about the past. Yes, it was that bad.  And yes, you made it through anyway!

The Importance of Alone Time

Alone time is a precious thing. But right now, with the self-isolation that accompanies the pandemic, many of us are experiencing too much “alone time.” But many of us need more.

Alone time has been important to me as I have struggled with bipolar disorder. I have a loving, supportive husband who is there when I need him to be. But even he knows that sometimes what I need is to be left alone.

Sometimes the world is too much with us, and we long to escape – read a book, hide under the blankets, just sit in the corner and think. At times like that, interacting with another person can feel like an intrusion, an annoyance, unwelcome. Alone time can allow you to catch your breath, calm yourself, practice mindfulness, or simply be alone with your feelings.

Of course, getting alone time is not always easy, especially now when we may be cooped up with our nearest and dearest, with no respite in sight. In my opinion, these are the times when a bit of alone time is even more necessary. Even with people you love, being with them 24 hours a day, every day, will begin to wear on you all. Stress builds and you may be triggered by noise, conflict, or other stimuli.

I’m lucky. That supportive husband knows, if his other efforts at drawing me out (offering me food, or a movie, or music) have failed, the greatest gift he can give me is alone time. He’ll even ask me if I need alone time, in case I don’t realize that is exactly what I do need.

I’m also lucky that there is a dedicated space in my house that is perfect for alone time – my study. It has a computer, music, comfort objects, games, favorite pictures, and more. It even has a comfy chair so that I can just sit and think if that is what I need to do. I know that I come at this topic from a place of privilege.

Making mental and physical space for alone time is harder when you have a roommate or a family that doesn’t understand the concept of alone time. The TV may be blaring, the washer clanking, the kids yelling, the spouse being needy. There may be someone in every room of the house, making noise or demanding your attention. Sometimes you can’t even be alone in the bathroom. You want everything to stop, just for a while.

In situations like that, you may have to ask for alone time. First, realize that it’s a reasonable request. Suggest ways to make it happen – I need to be alone in the basement (garage, kitchen, yard, whatever) for a while. Don’t disturb me unless someone’s bleeding or something’s on fire. Offer to return the favor. If you’re feeling pent up, chances are someone else in the house is too.

Of course, too much of a good thing is not necessarily a good thing. Even though I need a fair amount of alone time, too much can leave me stuck inside my own head, not always a comfortable place to be. I can brood, catastrophize, feel lonely or bored, give in to depression. It helps if I can recognize when alone time is turning toxic like that. When I’ve had enough alone time, I can choose to leave that behind and rejoin the world in a better frame of mind.

As far as I can see, alone time is vital for every person, even the very gregarious. It allows us to let go and drop our metaphoric masks. But alone time is particularly necessary for those with mental illness. The ability to be alone with oneself can be a powerful step in understanding and healing. And whether time alone is the norm or the exception now, people’s mental health suffers. Connection is what we hear most about – virtual meetings, video chats, texts, and calls – but alone time is vital too. Treasure it when you get some. 

Persistence of Memory

It is spring, sunny and pleasant, but the wind is blowing at 20 miles per hour. The boughs of the fir trees sway dramatically. The bird feeder glints in the sun as the light catches its swinging arc.

I am anxious.

There is a thunderstorm. Those same trees are tormented by strong winds. The hard rain doesn’t fall but blows sideways. Golfball-sized hail pelts the ground. I swear I can see lightning flash close to our house.

I am panicking.

About ten months ago, my life was changed when I lived through a tornado. Everyone says it was a miracle I survived. I was on the second floor of my house, with no time to get to the basement, when the roof came off. Assaulted by a maelstrom of flying dirt, insulation, and debris, I put a pillow over my head and hoped for the best. And I came through it without a scratch, although the house was damaged so badly that it had to be torn down. It’s being rebuilt right now and we hope to move in in a couple of months.

After the tornado passed, I was calm. I even slept with that filthy pillow as I waited for my husband and the rescue squad to come and extricate me from the bedroom. As the days passed, I had to deal with a lot of things that reminded me of the tornado – staying in a Red Cross shelter, dealing with the insurance company, going back to the house to rescue our pets and salvage a few belongings that had been in the least-damaged part of the house.

As time went by, I told my story again and again to friends and acquaintances who asked about it. Without exception, they were amazed not just at my survival, but at how incredibly calmly I talked about it and how I didn’t seem to be suffering from any post-traumatic effects.

Then why is it that, ten months later, I seem to be experiencing the anxiety and panic that should have struck me then? Heavy rain makes me nervous. Strong winds disturb me. Lightning makes me jump.

My husband thinks that it is because we are getting closer to the anniversary of when it all happened. And it is again tornado season in Ohio. I think it was not completely irrational of me to be afraid of the storm last week. I just wonder why it happened after all this time. Have I been in denial for ten months? Does it sometimes take that long for post-traumatic stress to manifest?

A friend of mine had a similar experience when her car was nearly hit by lightning. At first, she said, she was still able to drive to work. But as time went on, she became more and more frightened of driving through rain. As she put it, “Over time, my anxiety ramped up rather than down.” She had to have de-sensitization treatment.

Her explanation for the delayed reaction was that “the long-term memory encoded it.” Perhaps it’s possible that the lightning for her and the tornado for me lingered in short term memory and did not become troublesome until they were fully stored in our long-term memory banks. That sounds counterintuitive, but it may be right.

Will I be comfortable on the second floor of the house when we finally occupy it? Will I be able to sleep in the bedroom? Will every thunderstorm send me racing to the basement?

I just don’t know.

Systemic Breakdown and Involuntary Commitment

I don’t often review books in this blog, but Lynn Nanos has written one that has caused me to think long and deeply about an important topic, so I felt compelled to share my take on it.

The book, Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry, deals with the involuntary commitment of people who experience schizophrenia, psychosis, some mood disorders, and anosognosia (lack of understanding or awareness of one’s own mental condition). Nanos lays out her thesis logically yet compassionately, with lots of references to back up her opinions.

What Nanos says is that involuntary commitment should be more widely available and easier to accomplish. Her experience as a clinician in Massachusetts involved many instances when she was involved with administering “Section 12” orders for involuntary commitment.

I’ll confess my bias up front. I’ve always been leery of involuntary commitment. As a person with bipolar disorder which was long untreated and un- or misdiagnosed, I have suffered with the fear that I might be committed at some point in my life. I’m a great believer in civil rights and believe that patients should have the right to refuse treatment.

Nanos is changing my mind, at least in the case of psychiatric disorders which prevent victims from knowing their own needs and taking care of themselves. She makes an excellent case that schizophrenic and psychotic patients, especially those with anosognosia, are the most likely of all psychiatric patients to commit violence and be victims of violence. This she refers to as “dying with their rights on,” a powerful phrase.

As it currently works – or doesn’t – forced commitment often leads to a revolving door of hospital emergency department stays, early release from psychiatric units, and the patients who most need help being discriminated against by psych units that turn them away because of their potential for violence and the difficulty in treating them. This results in homelessness, overuse of emergency services, release to relatives ill-equipped to handle a schizophrenic or psychotic person, and other potential dangers.

Nanos thoroughly discusses Assisted Outpatient Treatment (AOT) and other versions of court-ordered therapy and medication. Though these strategies are not without their flaws, Nanos indicates that her experience with them is that they are substantially beneficial and reduce violent behavior significantly.

Breakdown does not imply that there are simple or one-size-fits-all solutions to the serious problems with emergency psychiatry. The part insurance companies and hospitals play in not supplying adequate treatment is not ignored.

Lest one think that this is a dry, academic tome, though, Nanos fills the book with empathetic and sometimes searing stories of people that the system has failed – both patients themselves and the victims of their sometimes violent behavior.

How has Nanos’s book affected my opinions on involuntary commitment and related areas? The criteria she recommends for the procedure are far from superficial: She posits that involuntary commitment should be used only for those who are actively schizophrenic or psychotic and are unable to recognize the nature of their disorder and are unable to care for themselves – especially if they have shown signs of violent behavior or serious threats. (“Unable to care for self” takes the place of the older “danger to self” and includes conditions like homelessness, malnutrition, etc., not just being suicidal.)

Do I now think that involuntary commitment and/or AOT should be easier to accomplish? Yes, with the understanding that easier does not mean easy. We’re still talking about people’s civil rights, and those should not be broached with serious thought and safeguards in place. But my own fears of being involuntarily committed are revealed to have been irrational, a product of my bipolar disorder.

Has the psychiatric “system” broken down to the point where involuntary commitment is a necessary and even a beneficial thing? The answer, sadly, is yes. Lynn Nanos’s Breakdown has convinced me of that.

 

Hitting the Plateau

Back in September, I wrote about my bipolar disorder being in remission and how much I loved that feeling. Now I’m not so sure. Maybe I’m not in remission. I’ve had significant setbacks, though not long-term ones. At one point I felt broken, but when that lifted I felt jazzed. Maybe I’m on a baseline and never wander too far off it. Maybe I’m stuck on a plateau, halfway between mental illness and mental health.

I ask myself, will I get any better?

It’s like when I had my second back operation (micro-laminectomy). When I went for a follow-up visit to the surgeon, I was no longer in pain. But I was slow and uncertain when walking and felt keenly that my physical capacities were diminished. “Will I get any better, or is this it?” I asked.

“You’ll improve,” said Dr. West. “It will take a while, but you’ll feel better.” And he was right. I did. But I still have some pain at times and sometimes I walk with a cane. I may be better, but I’m clearly not totally well. I’m not bitching (much). I know that once your back goes out, it never gets back to 100%. And I am truly grateful every day that I don’t suffer the excruciating pain of a bulging disk and a pinched nerve.

My bipolar disorder is like that. I am no longer suffering on a daily basis. My meds are working and haven’t changed much in years. My mood levelers are doing their job. But I still have symptoms. There are still things I can’t do, or do only with great mental effort. I’ve never been at 100% and don’t ever expect to be. And I am truly grateful every day that I don’t have the in-the-depths lows, the ever-edgy anxiety, for more than a few days at a time.

But I wonder, am I stuck on this plateau forever? Is this as close as I’ll ever come to mental wellness? Or maybe, I think, mental health is an illusion. I can’t remember a time when I was unaffected by my disorder. The plateau itself may be an illusion. Maybe I am still improving, in such tiny steps that I can’t see the change. Maybe a new medication or treatment will come along and remove more of my remaining symptoms. (I’m not counting on that, though.)

My bipolar disorder feels like it’s running a low-grade fever. I can get done my work and my blogs, but little more. I don’t feel in the least joyful. It may be that this is just real life getting me down –  the weather, politics, the endless details and frustrations I have to deal with while we’re rebuilding our house. Perhaps this is just a normal mood swing like everyone gets or a reactive depression to the aforementioned stressors.

That’s one of the constant worries once you have bipolar disorder – not trusting your feelings or your feelings about your feelings. Every setback scares me that I’m teetering on the edge, ready to plunge off that plateau. Realistically, I know that I am as stable as I’m likely ever to be.

My superpower seems to be overanalyzing. I may really be in remission.

Depression lies. Anxiety lies. So, perhaps, does the plateau.

Beautiful at the Broken Places

The Japanese have an art form or maybe a philosophy called kintsugi, which involves embracing the flawed or imperfect. Cracks or breaks in a pottery or ceramic vessel are repaired using gold dust and resin.

According to Wikipedia, “Japanese aesthetics values marks of wear by the use of an object. This can be seen as a rationale for keeping an object around even after it has broken and as a justification of kintsugi itself, highlighting the cracks and repairs as simply an event in the life of an object rather than allowing its service to end at the time of its damage or breakage.”

On December 29, I posted an essay titled “Broken” (https://wp.me/s4e9Hv-broken). In it, I described the despair and depression that finally hit me after a stressful year, one that ended with the news that my second book was not going to be published. It was an awful trigger for me, considering the amount of work and hope and myself I had already invested in the book, and how near it was to completion.

Instead, I have decided to embrace the philosophy of kintsugi. I may have been broken, but nothing says I can’t put myself back together and consider my mending an improvement. In fact, my therapist said something similar after I suffered an earlier breakdown: essentially, that I could choose what parts of myself I would restore and which I could cast aside. Recently I came across an old diary from that time. I have not yet decided whether to read it, keep it unread, or get rid of it. At any rate, I don’t think I’m strong enough to decide that now, given everything else that’s been going on. But there are other things I have decided to keep.

One of my decisions is to keep my first book, Bipolar Me, alive. It was went out of print this month, but I will be self-publishing it on Amazon. I won’t let the second book, Bipolar Us, die either. Right now I am exploring ways to make sure it will be published as a paperback as well as an ebook. It’s better than my first book, I think, and I want it to be available to people that might find help or hope in it.

To celebrate this decision, I have ordered a kintsugi-style bowl. (I can’t afford the real thing.) On the bottom will be written “My Story Isn’t Over,” which is also the motto that informs my semicolon tattoo. I will keep it near my desk, where I can see it often and let it remind me that beauty can come from the broken after all.

I also hope that the rebuild on our house, which was destroyed by a tornado, will make it more beautiful at the broken places. (The only thing that remained was the basement, so it’s really going to be all new.) At last I will have a home that I have had a hand in designing, choosing materials, and decorating. No more mismatched, hand-me-down furniture. No more rental-neutral walls and carpet. I can create my study as a place of comfort as well as work, one where my self-care items are readily available and the colors and decorations reflect a calm, steady mood. Again, it is a chance to rebuild something and make it better.

Most of all, though, I need to keep working on me. There are still cracks and breaks in my psyche that need to be repaired. It will take continued hard work and loving support rather than gold dust and resin, but I hope I can eventually convert my troubled life into a work of reclaimed art.

 

I’m Not Giving Up on You

Not you, Rachel, and not you, Paul.

Rachel, I know that your life has been shitty lately. I know that your health problems are overwhelming you and your depression is dragging you down to the deepest levels. I know your brother’s death by suicide still resonates with you and makes you think that there is an easy way to end your pain.

Paul, I know that your life has been full of drama and trauma lately. I know that the tasks of daily living get the better of you and the future keeps retreating further and further away. I know that you have barely any spoons each day and feel compelled to spend them on others instead of on yourself.

But I won’t give up on either one of you.

Rachel, I will take your calls even when I’m exhausted and listen while you vent. I will support you in every way I know how. I will honor and thank you for your generosity when I know that you could easily focus only on your troubles. I will maintain contact even when I am low on spoons.

Paul, I will keep sending you reminders that I am thinking of you and offering you solace and support. I will willingly accept that you are not able to reply just now. I will not take that as a reason to make a break with you. I will keep trying.

Rachel, you know you can say anything to me, for I have surely been there. You know that your suicidal ideation makes me uncomfortable, but I won’t ask you never to speak of it. I have had those thoughts myself and gotten through them. I know you can too. I see all the things that you do to reach out to others and extend your goodness to them. I empathize with your difficult family situation. I don’t know what to do about it, but I will acknowledge the pain that it gives you.

Paul, you know that I have listened to you in the past and will continue to do so, no matter what it is you have to say. I will not let my own anxiety and depression stand in the way of listening to yours. Please know that I understand what you’re going through more than I can say or have ever said.

Rachel, please know that I celebrate with you even the smallest achievements you make. When you are able to stand up for yourself against City Hall, I applaud you. When you investigate ways to make your living situation better, I will not judge you, though they may seem harsh or unacceptable to others.

Paul, please know that I wish only the best for you, even if I don’t always understand what it is that you need. I admire your continuing strength, even when I feel that it would be good if you could lay your burdens down for just a while. I acknowledge that I am not the person that can help you do this, much as I would like to.

The reason that I say these things is that I want you to know that there is someone who does truly understand and truly care. I have been where you are and have found my way out, at least a little. I remember the people – including you two – who have reached out to me even when I was not able to reach back. The very least I can do is to do the same for you.

When you are relieved of your burdens and can again see the light of day, I will be there to celebrate with you. I will not despair or think that you can never see that light.

I will not give up on you. I will not give up on any of my friends who are burdened with depression, anxiety, or some other difficulty. I will do what I can, because I must. There are people who have never given up on me. I know what that feels like, and I wish that same healing and help and health for you.

In Remission

My bipolar disorder is in remission. I know I’m not cured. There is currently no cure for bipolar. But I’ve reached a point where I’m stable enough that I don’t expect a crash or a buzz to descend on me at just any old time.

I still get moods, of course. They’re just not severe or long-lasting enough to be symptomatic. Yesterday, for example, I spent several hours wrestling with phone trees and people who wouldn’t switch me to a supervisor when all I was trying to do was straighten out a couple of bills that contained errors. Afterwards, I felt frustrated, cranky, and a bit sad. But those were normal emotions, based on what I had just gone through. After a nap I felt better, and dinner blew out the remaining cobwebs. Napping is definitely better than staying in bed the entire next day.

Of course, I didn’t achieve remission alone. It took years of doctor visits, therapy, and medications to reach this state. I am particularly grateful for mood levelers. For me, they actually do what they’re intended to do. They keep my moods within an acceptable range, or at least one that’s acceptable to me.

Too many people fear mood levelers, I think. Level moods sound boring – as though there are no variations, just a blank, straight line. That simply isn’t so. Mood levelers have pushed the spikes that used to go wild in either direction to a less extreme range. If you think of mood as an EEG, mood levelers prevent the lines from going off the charts, settling them to fluctuate within a middle range that most non-bipolar people have naturally.

I think the term “mood leveler” scares some people. They seem to think that such a drug would make them perfectly level, robotic, unchanging. They fear that any spark of personality or creativity would be lost.

That’s not the case. Instead, with level moods – and especially for depression-prone bipolars – a person has much more ability to explore his or her creative side.  I know that’s true for me. Now that my moods are stable and level, I’m able to get more writing done, but also to tell whether the work is good or needs serious revising before I post it.

My doctor recently increased the dosage of one of my medications, a mood leveler, because I was having trouble with hypomania that wouldn’t let me sleep. And it worked. I am now getting seven to eight hours of sleep each night and have enough energy to at least face the day, if not always to conquer it.

Don’t think mine has been a case of spontaneous remission. I’m not sure I believe that’s possible with bipolar disorder. It’s taken a lot of years and a lot of work to get to where I am today. For example, it took literally years for assorted doctors and me to find a combination of chemicals, a cocktail of psychotropics, that would work for me. And during all that time, it was as if I was not medicated at all. Only the right combo of drugs and dosages would unlock my brain and level my moods.

So, here I am, in remission – and I love it. My moods aren’t blunted, they’re leveled. I am not as fearful now that my extreme moods may return and wreak havoc on my life. Oh, I still have some symptoms and side effects that remind me I’m not cured. But now I know that remission is possible, with work, with luck, and with the right mood levelers.

Nothing to See Here

Many people with SMI are afraid that it shows, that other people can see automatically that there is something wrong with them. They feel as though they stand out in a crowd. Everyone notices them, and probably talks about them.

I have the opposite problem. My bipolar depression makes me feel invisible. It’s not just that SMI is often an invisible illness. It’s that I myself seem to become invisible. I think of myself as a particularly ineffectual ghost, frightening no one and unable to affect anything in my environment. Some people call this dissociation.

At first, I made the best of it. I’m especially invisible when I’m out in public and reading a book. So I found that if I was at a business convention and wanted to remain invisible, my best strategy was to sit alone at a table and read a book. Only once did a man approach me while I was so engaged. No one else ever did.

Apparently, though, I don’t need a book to disappear. Maybe it’s anxiety that makes me keep quiet when people around me are discussing something interesting. Maybe it’s my instinct not to be noticed so I won’t be subject to derision or worse. Either way, I can’t seem to catch anyone’s eye or add my bit to the conversation. I blend into the crowd, even if it’s only a crowd of three or four.

It’s almost like there’s some aura around me when I’m out in public that says, “Don’t notice me,” like Harry Potter’s cloak of invisibility. I do not use my invisibility for pranks or mischief, though. I don’t use it intentionally at all (except for using a book, as I mentioned).

Why do I think this invisibility is part and parcel of my bipolar disorder? It could be imposter syndrome at work. I feel so unworthy that I don’t want anyone to see me for what I am. Or it might be the anxiety component of my hypomania that keeps me from presenting myself more assertively. Or maybe people can see that I have a troubled mind and simply look away.

I am slowly learning to make myself seen and heard. I find that calling people by name makes it easier for them to see me. It seems to signal them that there’s another person in the vicinity. And once I even set up an occasion where I would be the center of attention, speaking about my bipolar disorder at a signing for my book.

I also use my writing to make myself “visible.” This blog (and my other one) and my books give me a presence, though not a physical one, even at a distance. When I see likes and follows and sales, I know that someone has noticed me, or at least discovered that I exist.

I sometimes think that going out in public more – practicing being visible – might help. But actually, that’s when I feel the most overlooked, the most unseen and unheard. The most lost.

Perhaps what I need is to go out and meet a specific person, someone who expects to see me. Then I could be guaranteed of one person who would see me.

But it has been suggested to me that I may not want to be seen at all – that I would prefer to fade into the background, not put myself forward and disappear from the stresses of being seen. Perhaps that is true, or at least once was.

Now I think I would prefer to be seen, flaws and all. If someone cannot tolerate the sight of me, a mentally disordered person, or glances over me as if I did not exist, I think I shall insist on being seen. I will use my voice, my (admittedly glitchy) brain, and my human physicality to assert that I exist, that I matter, that I have something to say.

And in social situations I will try to assert myself (if politely) to join the public discourse and add my two cents, whether the subject is mental illness or the latest bestseller.

I exist. I deserve to be seen. I will not remain invisible.

Tag Cloud

%d bloggers like this: