Bipolar 2 From Inside and Out

Posts tagged ‘metaphors’

What Is Bipolar Disorder Like?

There are a number of metaphors that try to express what it’s like to have bipolar disorder, and none of them is accurate. Thanks to television commercials for bipolar medications, we have even more metaphors, none of which express the reality of the disorder. Maybe, at heart, it is futile to try to come up with a metaphor. The map is never the territory. But let’s examine some of the most common and see where they succeed and where they fail.

Depression

The Black Dog

Winston Churchill was notoriously given to episodes of depression, and he referred to them as “The Black Dog.” It would come and go, but when it was with him, he descended into the depths. (Of course, this did not prevent him from becoming Prime Minister of England and making significant policy decisions and speeches during World War II.)

Dementors

J.K. Rowling has said that the soul-sucking monsters that appeared in the Harry Potter books were metaphors for depression, being able to remove not only joy and happiness from a person’s soul, but the memories of those emotions, and the possibility of ever feeling them again. (Incidentally, once out of the Dementors’ grasp, chocolate is said to help the person recover.)

Masks

This one is popular in TV commercials. A woman (almost always a woman) holds a smiley-face mask in front of her face to cover up her sad expression. Then, after she takes psychotropic medication, she puts the mask in her purse or pocket and suddenly reveals her own smiling face. Or a stock photo shows one person with a brown paper bag over his or her head with a sad face drawn on with marker. This bothers me because it implies that medication takes effect almost immediately, but I suppose there’s no way to show the six-week lag in TV ads.

Fog

The underlying metaphor here is being lost and being unable to find your way out. Everything around you is gray (and most likely rainy) and indistinguishable. It’s difficult to impossible to find your way through. This is actually a fairly accurate metaphor for severe depression or a major depressive episode. The sense of futility, of immobilization or being lost, of being unable to see a way out, is common to people with depression.

Anxiety

Skin

One of the most common sensations reported by people with anxiety is being about to jump out of their skin, or feeling itchy or twitchy all over. The itchiness or twitchiness may manifest in actual physical symptoms, in which case they’re a perception, not a metaphor anymore.

Electricity

The feeling of shocks running through the body or the brain is another way we describe anxiety. It can feel like jolts of current that only add to the twitchiness or agitation.

Indecision

Sometimes the paralyzing side of anxiety is represented by having too many choices or being unable to decipher a map. Instead of being agitated, the person is stymied and motionless. Make no mistake, this is a symptom of anxiety as much as it is one of depression.

Mania

House of cards

This metaphor comes to us thanks to a TV commercial. A person suffering from mania confronts a pyramid made of playing cards, climbs it, and keeps climbing until there are only a few cards left, with the idea that they will ultimately tumble. There’s no indication, though, that the person with mania built the pyramid of cards themselves, and the medication kicks in before the stack ever falls.

Soaring

The feeling of flying is often associated with mania. Soaring far above the mundane and the insignificant, the person with mania feels a sense of grandeur and empowerment, the ability to do anything – and to sustain it. Of course, sustaining the feeling never quite happens. Persons flying high with mania never see the inevitable crash that is coming.

Bipolar Disorder

Playground equipment

The seesaw. The teeter-totter. Even the swings. These metaphors certainly catch the up-and-down, back-and-forth motion of bipolar cycles. There are just two things wrong with these metaphors: They portray movements of equal length. And they’re fun. Bipolar moods do not come on a schedule or last a predictable amount of time. And there’s nothing fun about bipolar disorder.

Rollercoaster

A rollercoaster is perhaps the most common metaphor for bipolar disorder. It improves on the playground equipment analogy some. A rollercoaster, like bipolar, can be scary, especially the first time you experience it. It does involve up and down motions of unequal length. But the rollercoaster has the process backward. The climb up is slow, not an exhilarating whoosh. The swift ride to the bottom is the exciting part, which of course it isn’t. And, of course, once you’ve been through the whole route once, you have to get off and pay to get on again.

We use these metaphors because it’s almost impossible to convey what bipolar disorder is like to someone who’s never experienced it. And they can never convey the reality. Among those of us who have experienced the disorder, we use them as shorthand to describe the feelings we share, at least to some degree, with one another and with others, in hopes that they’ll “get it,” even just a bit.

But language has its limits, especially when it comes to describing what’s going on with our brains and emotions. Sometimes metaphors are as close as we can get.

Bipolars, Rollercoasters, and Sex

The rollercoaster is the most common metaphor for bipolar disorder. But is it really the best one?

Wooden RollercoasterAfter all, a rollercoaster has long, abrupt downward swoops, and anticipatory highs. (At least the ones I’m familiar with. I won’t go on the ones that turn you completely upside-down.) But rollercoaster highs crank slowly, grindingly up. Mania isn’t like that. Boom! You’re suddenly at the top.

Nor are rollercoaster lows like the lows of depression. If they were, the downward slide would not be the exhilharating, thrilling part of the ride, and would not immediately be followed by another high. Instead the rollercoaster would plod along through a lengthy trough, or maybe a tunnel (though not of love), with no idea of when the next up would come.

Perhaps a seesaw is a better metaphor. Its ups and downs are quick, and you can stay stuck in either position for an undetermined length of time. And a seesaw is all about balance.

But no. A seesaw requires a second person to operate correctly, and that is certainly not the experience of a bipolar person. Our brain chemistry alone is enough to get us going up and down.

A pogo stick? The spring gets squashed and then rebounds. But it’s a rhythmic bounce, not one that you don’t see coming until you’re in it. (If then.)

The basic problem with most of the usual metaphors is that they involve fun at some level. Bipolar is not fun. Oh, the mania my be enjoyable – for a time. But the gut-wrenching drop does not make you go whee!

So how about a soufflé? It can rise or fall, and you never quite know which it’s going to do.

Or a computer? It can open up the world, but is going to crash sometime, inevitably when you most need it to work.

I suppose we could split it up. Mania is a fountain and depression is a ditch. Depression is a b&w rabbit-ear TV and mania is cable with 1000 channels. Mania is a battery and depression is a dead battery.

The root of the problem is that no metaphor can adequately explain bipolar disorder. Even Spoon Theory, useful as it is, explains only the effects, not how the disorder itself works and feels. A metaphor may capture one half of the experience – the ups or the downs – but not the reality of both.

If it’s not possible to explain bipolar disorder with a metaphor, why do we so often try to? Because, really, only people with bipolar know what it is like, and the experience even differs from person to person. A psychologist or psychiatrist may understand the mechanisms and the biochemistry and the complications and the medications. But she or he is essentially watching from the outside.

My husband didn’t really “get” depression until he fell into depression himself that lasted a couple of weeks. “Now,” I said, “try to imagine that feeling lasting for months.” He couldn’t, but at least he was closer to understanding.

My mother-in-law, who doesn’t “believe in” mental illness, now has a clue too, since she experienced a profound reactive depression.

Neither of them really “gets” mania.

Maybe the best metaphor is that bipolar disorder is like sex. You can’t adequately explain it to someone who’s never had it. And even when you’ve had either sex or bipolar disorder, you only know what it’s like for you. You can generalize your experience and share commonalities, but basically, every case of bipolar is something a person goes through alone, or maybe alone together, as Jenny Lawson says.

Bipolar disorder.

It is what it is.

Sensation in the Brain

I know there is no physical sensation in the brain. It cannot feel pain. It cannot feel touch. Even in a car accident when the brain sloshes from side to side and bashes against one side of the skull and then the other, the brain sustains injuries, but feels nothing.

That notwithstanding, twice in my life I have felt physical sensations in my brain – or at least what felt like them.

The first time was at the dentist. I am terribly phobic about dentists, so even for routine procedures I need anti-anxiety medication. This was not a routine procedure.

The dentist was very understanding. He put me in the children’s treatment room, which had brightly colored designs of cactus, coyotes, cowboys, all painted on the walls in comforting colors and playful attitudes.

He also brought in a traveling anesthesiologist so that I could be unconscious during the procedure instead of terrified. My husband was there with me, of course, both to drive me and to give me moral support. (It also turned out that he had to give permission for one of my teeth to be removed in the middle of the procedure while I was unconscious.)

While the anesthesiologist was putting me under, my husband and the dentist were casually chatting. My husband made a remark and the dentist said, “Oh, she can’t hear us now. She’s already pretty far under and won’t remember a thing.”

“I bet she will,” my husband replied. The bet involved giving me a word to try to remember when I awoke. They selected the word green.

“You mean like the color of my pants?” I said. They were actually more like olive drab.

“Yes,” the dentist replied. “Green – the color.”

Just for the hell of it, as I was sinking into unconsciousness, I silently repeated to myself the word green in a slow and steady manner: green green green – until the drugs took me under.

An unknown time later I awoke. The dentist asked me, “Is there something you were supposed to remember?” I shook my head groggily.

As soon as I did, I felt an odd sensation in the back of my brain. It was like a little bubble rising up through liquid. When the bubble reached the surface of whatever the liquid was, it burst and released the word green. “Green?” I said uncertainly.

“See?” said my husband. “I told you she would remember.”

The other sensation in my brain came about six weeks after beginning a new psychotropic medication. I had gone through a long, miserable time of trying drug after drug after drug – tapering off on one and ramping up on the next – all with no effect, except unpleasant ones.

Dr. R. was ready to recommend electroshock for me. And after such a long time – I think it may have been two years – of trying and failing with different medications, I was ready to take the plunge. I admitted as much in one of my sessions.

“There’s one more thing I’d like to try before we do that,” said Dr R. “Here is a prescription for lamictal”.

“Okay,” I said. “How does it work?”

“We don’t really know,” he replied. This was our standard conversation whenever he prescribed a new drug. I was used to it, but I always asked anyway.

So I tried it. And felt the usual nothing for almost six weeks. Then one day I was in my husband’s study and we were talking, when I felt it.

It was the physical sensation in the back of my brain of a light switch being flipped. I thought I heard an internal click. When that switch flipped, suddenly something in my brain changed. It remembered how to think and to feel and to not be miserable.

“Oh!” I said. “I remember this. This is the way my brain is supposed to work.” Since then it has kept working – not continuously in the proper manner – but often enough that I consider the drug a success.

I know that in both of those cases nothing happened in my brain that caused a physical sensation. Both times, my brain gave me a metaphor for what was happening. In the dentist’s office the metaphor was a bubble rising to the surface to explain coming out from under sedation – and a little bit of self-hypnosis.

In the case of the drug, the metaphor was the cliche of flipping on a light switch. This time something had changed in my brain, something biochemical. I should not have been able to feel it, but according to my brain, I did.

It seems I have a clever brain. It gave me ways to understand what was happening in terms I could relate to. The fact that I know the brain can have no physical sensations did not matter to my brain.

Human brains are amazing – and sometimes even in a good way.

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