Bipolar 2 From Inside and Out

Posts tagged ‘my experiences’

A Bipolar Breakup

A recent issue of BP magazine had an article on surviving a breakup as a person with bipolar disorder. It noted that “a split can trigger manic or depressive episodes.” It also noted that “there’s typically a period of destabilizing upheaval as the newly single adjust to life on their own, perhaps in different surroundings.”

I can vouch for the mood episodes and destabilizing upheaval. My senior year in college, I experienced a breakup that was not just destabilizing but devastating. At the time, I was not diagnosed, but it’s now clear that I was in the grip of a major depressive episode, between not having any idea what would happen to me after college and the train wreck that was the relationship.

The article also described how to maintain stability, avoid dangerous rebounds, and prioritize self-care when a relationship ends. They advised readers to avoid rebound relationships, not stop their medication, see or seek a mental health professional, avoid isolation by using their social support network, take their time, and allow themselves to heal.

This is no doubt good advice, but it’s easier said than done. I wasn’t able to put all of it into practice. I had no mental health professional (and wasn’t ready to look for one), and was unmedicated, unless you count the benzo I was given for my TMJ problem and the wine our neighbors poured for me.

As for rebound relationships, I met the man I would eventually marry the weekend before I left where I was living to return to my home state. But it’s hard to call it a rebound relationship, as for over a year, we saw each other only twice, but simply corresponded. So I guess you could say I took my time.

However, one year wasn’t all I needed to heal. Neither the flashbacks and nightmares nor the crying were finished in that time. I had to repair my relationship with my parents. I had to realize that I needed psychiatric help and begin that journey. I had to rebuild my social support system and find the wherewithal to interact with them.

When you consider everything, it took more than a decade. By the time my “rebound” guy and I got married, I was still not healed. He had to cope with my distress as I tried to shake off the memories. He tried to understand my longstanding depression (but really couldn’t until he experienced a depression of his own). The people in my support system soon realized that I would back out of plans, often at the last minute, and that if I did show up, I could be preoccupied and uncommunicative.

The good news is that I finally did heal. My husband and I now have a strong relationship unclouded by the specter of that failed one.

So, what would I advise someone to do in the aftermath of a bipolar breakup?

First of all, take the time you need to heal, and don’t worry if it doesn’t happen quickly. The death of a relationship engenders grief. And as with the death of a person you cared about, grief takes as long as it takes. There is no official timeline or cut-off point. I’m not saying you should dwell on a past relationship, but that there are many facets to such a breakup, and you may have to heal from one after another. You can’t rush it, so don’t try. Unresolved memories and grief can pop up again when you least expect them.

Next, while you’re taking your time to heal, also take the time to do the work. Find a therapist or psychiatrist and go to your appointments faithfully. If they give advice (they may not), take it. If they give you homework, do it. If they say something that resonates with you, think deeply about it. See where it fits into your life and your situation. If it doesn’t seem to do so, discuss it further in a later session.

Finally, don’t overlook “glimmers.” These fleeting reminders of the things that remain good in your world are worth treasuring. What they are will be personal to you. The sight of a blue jay flying past your window or hummingbirds fighting over a feeder. The smell of cinnamon rolls baking. The sound of a song you love being played over the sound system of a restaurant you visit. The cuddly warmth of a blanket or a hug. The taste of your favorite kind of chocolate. Use all your senses to identify the presence of things that bring you, if not joy, at least a smile.

Give it time. You will get over that relationship.

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Mental Health

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Lifelong Meds?

I was in my 20s when I started taking Prozac. Now I’m nearing 70 and still taking SSRIs, though the names have changed over the years.

When I was first diagnosed with depression (which was before I was diagnosed with bipolar 2 and anxiety), I understood it to be a lifelong condition. When my diagnosis changed, I still thought of it as a lifelong disorder requiring lifelong treatment. So far, that has proved to be true. I have been on antidepressants ever since and fully expect to stay on them forever, or at least until a cure is at last found.

Recently, however, the New York Times published an article that examined whether the received wisdom was still true. Did someone, once prescribed antidepressants, whether for depression, OCD, PTSD, or another mental illness, have to continue taking them for the rest of their life? The article noted that the FDA’s approval of the drugs was based on trials that lasted only a few months. Other “in-depth” studies lasted two years or fewer. The Times also noted, “Current clinical guidelines do not specify the optimal amount of time they should be taken for.”

Many people stop taking antidepressants on their own, based on side effects and a dislike of them, the fact that the drugs seem to stop working (either fairly quickly or over the long term), or simply because they dislike taking pills. According to the Times, however, “The answer depends on your symptoms, diagnosis, response to the medication, side effects, and other factors—all things to discuss with a medical professional.” In other words, cold turkey isn’t the way to go. With psychotropic drugs such as benzos, it’s positively dangerous, and quitting antidepressants brings the risk of falling back into the depression you and your doctor were trying to alleviate. Tapering off the drug with the help of your prescribing physician is recommended.

And about those side effects—some disappear over time as the body gets used to the medication, but others, particularly annoying ones like weight gain, sexual dysfunction, and possibly increased heart symptoms, linger. A doctor can prescribe a different drug in hopes that the side effects will not be so severe, but they may only be similar or worse. Patients generally don’t like tinkering with their medication and having to wait weeks until the effects appear and the side effects disappear. It’s a tedious and discouraging prospect.

What do the clinical guidelines say? Experts say that antidepressants, once they work, should be taken for four to nine months. Any quicker than that, relapse may occur. To maintain the positive effects, they should be taken for two to four years. Taking them for longer periods is sometimes advised, depending on how long the depression lasted and whether the patient has had several depressive episodes. Long-term use depends on whether the illness has continued for a long time and whether the depression is very severe, causing hospital stays and a loss of the ability to perform daily functions.

All in all, says Dr. Paul Nestadt, the medical director of the Center for Suicide Prevention at the Johns Hopkins Bloomberg School of Public Health, “I’m still of the opinion that, in people who have real depression, the benefits outweigh the risk.”

So, continuing to take antidepressants is really up to me and my doctor. At this point in my life, I see my doctor quarterly for a med check. We sometimes tinker with the dosages, based on my symptoms at the time, but for the most part, we stick with what has been working. As the saying goes, “If it ain’t broke, don’t fix it.” And since it ain’t broke, I’m content to keep taking my antidepressant (and other medications) for the foreseeable future.

Note: This post is not medical advice and should not be taken as such. Discuss medical questions with your physician, especially before stopping a medication.

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What’s the Future of Ketamine Treatment?

You’ve likely heard about the use of ketamine and other psychedelic drugs in the treatment of SMI. Many people have found it helpful for alleviating—though not curing—treatment-resistant depression and PTSD. Ketamine, long used as a surgical anesthetic, is given for mental health purposes via IV or injection as an off-label use or as an FDA-approved nasal spray, under the supervision of a doctor.

It’s that supervision of a doctor that’s proving to be a problem, now in Texas and perhaps in other states soon.

On December 3rd of this year, MindSite News Daily published a story about ketamine being under fire in Texas.

The state of Texas has permitted clinics to administer ketamine if they’re under the supervision of a licensed physician, such as an anesthesiologist—though not always one onsite. The off-site doctor sometimes has nurse practitioners, paramedics, or physicians’ assistants perform the actual procedure at the clinic. It’s a form of telemedicine. But a change in the rules, influenced by the Texas Medical Board and the Texas Society of Anesthesiologists, might mean that Texas clinics will have to have a doctor physically present.

It’s true that ketamine has been known to produce trance-like hallucinations or, in some cases, even heart failure. And it may interact with other medications like benzos that a patient may be taking. In non-medical circles, ketamine is known as a “party drug” referred to as “Special K.” And, naturally, no physician is usually present at these parties.

But when used correctly under the supervision of a professional, ketamine may result in a trance-like state that can even alleviate suicidal thoughts. Until now, Texas has been a leader in using psychedelics such as ketamine and exploring psilocybin or ibogaine to treat PTSD or MDD in particular. The number of veterans living in Texas makes this procedure especially needed.

I experienced ketamine recently, as an anesthetic after I broke my ankle in two places. The doctors seemed a little wary about giving it to me, given all my other meds. But they discussed it with me and I decided that it was better than being put all the way out.

Ketamine is definitely a psychedelic. When the drug hit, I began seeing everything as a series of see-through squares, like the kind of glass they use for bathroom windows, except they stretched and moved. It reminded me of the movie Minecraft, where everything is made of blocks. My husband watched as the doctor manipulated my foot in unpleasant ways. What I felt wasn’t pain—more of a stretching sensation that made me groan a bit. (My husband said that I cried out, but it didn’t seem like that to me.) That was probably when they hit me with another dose. Gradually, I came down, and the squares resolved themselves into emergency room curtains and assorted medical gear and people. Then I was trundled off to the operating room for more traditional anesthesia so they could put in some pins and plates.

All in all, it altered my perceptions for a short time, but at no time did I feel euphoric. It did its job in regard to pain, but had no lingering psychological effects that I could see. But then, the doses I received were calibrated for a specific purpose, which had nothing to do with my mental difficulties.

Would I have tried ketamine treatment for the medication-resistant depression I once had? I might have—at least if I had experienced its pain-relieving qualities. Having grown up in the 1960s, I was wary of psychedelics and their reported effects and dangers. Then again, I was ready to try ECT until another medication, added to what I was already taking, finally proved effective.

Then again, the off-label use is not likely to be approved by insurance, and I don’t have the kind of money a course of treatment would require. The nasal spray is a relatively new method of administration and is generally covered by insurance. So it’s highly unlikely that I would ever have agreed to ketamine treatment for my SMI, at least until a broken ankle introduced me to it.

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Mental Health

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Staying Home

This is our house, and it’s pretty great. When I first saw it, I thought it looked like it had just grown up out of the earth. The main bedroom is large, and there are two smaller bedrooms that have become studies, one each for my husband and me. A great room. A deck. Over and under double ovens. Over and under space-saving washer and dryer. All electric. Over an acre of land, mostly woods, with lots of flowers in the front yard. Quiet cul-de-sac. A modern, new hospital practically within walking distance. A mall and other stores nearby. Close to my husband’s work, my doctor and PT, restaurants, and assorted other amenities.

I almost never leave my wonderful house.

Oh, I go out to doctor’s and PT appointments. My husband can occasionally get me to go out to have a meal. And I get out for other reasons from time to time.

But not often.

We have only one working car, and Dan needs it for work. He works in a big grocery/home goods store and does what shopping I can’t do online. I work from home, doing ghostwriting and editing, and take care of our financial matters online, too. I keep track of all our appointments and subscriptions. Anything that can be done on the phone or computer, I do. I’m not completely useless.

However, I stay home most of the time, living in pajamas or sweats. I know there are people with agoraphobia, movement disabilities, depression, and other conditions that keep them from going outside.

That’s not me. There’s no mental or physical reason I can’t leave the house, though there are limitations on how long I can stand and how far I can walk. These are (I hope) temporary. I do have an anxiety disorder, which may contribute to staying home, but back in the day, I used to travel domestically and abroad, sometimes with my mother or husband, or by myself.

There are excuses I use for not going out. Too much walking. Bad weather—heat, rain, snow, or cold. Fear of falling. My husband’s hours at work. Not having a car I can use when he’s at work. Errands that require only one person to do, such as getting the car’s oil changed.

Back in the day, Dan had a cat that was so chill he could ride in a car without causing a ruckus. When I didn’t want to run errands with him, Dan would scoop up the cat and say, “C’mon, Matches. You’re coming with me.” And off they’d go. I wasn’t properly treated for bipolar back then and had many profound depressive episodes. I knew this maneuver was directed at me, but I didn’t care.

If I do have to go out, we try to make it an occasion—having a meal out before or after PT, for example, if we have the money. I’ve been to a couple of special movies shown on the big screen, with dinner before or after. Visiting a friend in the nursing home and bringing her a gift or treat. But if I don’t have to go out, I simply don’t. And if I do go out, it had better be within five miles of our house.

So, the choices for why I stay home: I still have depressive spells that immobilize me; I still have anxiety that makes braving the world outside seem treacherous; I’m content to let Dan do everything that needs to be done elsewhere; or I simply prefer not to leave the cozy place where I have everything I need.

I would like to travel again, though. But that won’t happen until my purely physical problems are resolved. Until then, I’ll do the best I can inside four walls of safety.

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Love, Hate, and Mania

Mania, or in my case hypomania, is easy to love. It creates a buzz that carries you along, although you’re not always sure where to. Ordinary things become extraordinary, and extraordinary things become magical. I love mania. It can be fizzy, like champagne.

I hate mania, too. When it leaves, it leaves a hole behind. It leaves depression that’s like a nasty hangover. And many times, it can leave consequences. Sometimes dangerous. Sometimes shameful. Always unexpected.

I’m in the grip of hypomania right now. I recently got through a series of medical difficulties. Now, I’m back home, and not dependent on nurses and aides to bring me meals and wipe my ass. It’s glorious. And I’m celebrating by enjoying a burst of benevolence. It’s holiday time, and I’m back to my computer with a debit card and a desire to shop. That gives me an excuse, if not a reason.

I’m buying gifts for Dan and a few friends. I’ve bought so many for Dan that, now that the packages have started arriving, even I am a bit embarrassed. Fortunately, he has a birthday in April, and I can save some of the gifts for that.

In the past, Dan had the advantage. He could follow me around and watch what I oohed and aahed over, then sneak back and get it for me. But I am buying exclusively online now because I rarely go out. Dan doesn’t know how to buy online. I’ve offered to show him, but all the financial stuff goes to me, so I’d know where he bought stuff and how much he spent on it. This leaves only the store where he works to buy gifts. And he says he doesn’t know what to get me anymore, as I spend most of the day in pajamas and don’t wear earrings at home, so clothes and jewelry are pretty much out.

Anyway, I’m definitely manicky. I can tell. And I’m definitely spending more than I should. Fortunately, I just got paid for a freelance job I did, more than I usually get, so I haven’t gotten us into financial trouble, though it was a close thing. The check came just in time.

So. I’ve loved buying presents. I hate that I almost overdrew the bank account. I’m happy that I was saved by a check. I hate that the shower of presents may embarrass Dan, who won’t be able to reciprocate in a like manner.

Manic and hypomanic episodes are like that. A buzz and then self-doubt. A thrill and then regret.

I used to wish that I had mania too, instead of just depression. My theory was that if I were manic, I would get more accomplished. But I once knew a woman who had bipolar 1, rather than 2, so her manic episodes were more extreme. And her plans crashed and burned around her. She would start a project, tear it up, and redo it, even more than once. Her sense of humor was extreme and not really funny. (Once she mimed swallowing a whole bottle of pills.)

After that, I no longer wanted to be manic. But, as it happens, when my depression stabilized, my hypomania had more room to express itself. I haven’t indulged in the more dangerous behaviors, like drinking and driving. But this month, I can’t deny that I have hypomania.

I’m getting better at telling when it’s going to happen. Once I’m in the episode, I know. I feel the buzz. I notice the bank account dwindling.

Dan notices when I’m getting manicky, too. I can usually tell him that I feel it coming on and check it out with him. But this time, secrecy was part and parcel (literally) of it. Once it was getting beyond my control, I told him. Not about almost overdrawing our account, though. Once there was money back in the bank account, it didn’t seem necessary.

I’m not quite over this episode. I’m cooled down enough to rein in the buying. Just a couple more small presents for friends. I swear. It’s progress, anyway.

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Mental Health

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Time Out

It’s been a while since you’ve heard from me, and I wanted to explain. I’ve been in and out of the hospital.

No, not the mental hospital. All this was purely physical. Well, it had certain effects on my mental health, but the reasons for my multiple stays were due to my body, not my brain or emotions.

It all started back in April, when I had my left knee replaced. This was a long-anticipated thing, necessitated by the fact that my knee was “bone on bone” (the doctor’s words) and the fact that the steroid shots were no longer working.

I will admit to having possibly unwarranted fears that I would wake up from anesthesia with mental deficits. I was assured that this had never happened. (I assume they meant while having a knee replacement, not ever. It has to have happened ever.) So I sucked it up and went under the knife, as the saying goes.

The operation went well. The aftermath, not so much. Time in the hospital, learning how to use a transfer board and walker. So far, so good. But when I went home, it turned out that I wasn’t healed sufficiently to be on my own. I fell. And kept falling. After one fall resulted in a pretty bloody shin, I was advised to go back to the hospital to make sure the artificial knee was still in its proper place. I then went to a post-acute care facility (nursing home), where it turned out I had an infection on my still-not-entirely-closed scar. I stayed and got PT.

Back home. No more falling (thanks, PT). But three days later, my leg swelled up from my toes to above my knee. I called the nurse hotline, and they advised me to go back to the hospital, where they determined that the fluid was not building up in my heart, as feared. Back to the rehab. I practiced walking and got to the point where I could (sort of) climb stairs.

Back home. Then I fell in my study and broke both sides of my ankle. Back to the hospital (fentanyl in the ambulance, ketamine anesthesia while they set it, and general anesthesia while they put in metal pins and plates). Back to the rehab, leg swathed in bandages and not allowed to put weight on it. (Ever tried standing while putting no weight on one foot? Don’t.) PT became interesting. The only way I could use a walker was with a knee sling, which is, at the least, awkward.

Finally, I got a boot and was able to put some weight on the foot. PT went better from then on, and after a while, they took the boot off and allowed me to put full weight on the foot. Eventually, I came home.

While I was at the rehab, I didn’t take my laptop. In addition to the fact that I was on pain meds and muscle relaxants for a lot of the time, I worried that my electronics would be stolen. So, no writing.

Now I’m at home, having outpatient PT, and I walked 250 steps with the walker yesterday.

But this blog is about my bipolar disorder. So, here’s what happened to my moods.

I tried hard and managed to stay mostly positive, like those TV commercials where people hold a little smiley face card in front of their faces. I faked this by slapping on a perky affect and making my voice rise in pitch when I say, “Yes, I’d love to go to PT.” “Yes, a shower sounds great.” “Can I try 15 minutes on the stationary bike today?” or “Next, I’d like to learn how to stand and pivot. Is that something I’d be able to do now?”

I did this especially for the PT folks, who took my willingness to try as a sign of progress. But there were times when I realized how impaired I actually was, and I felt depression. My husband has been very supportive, but he’s also pressuring me to get to where I can climb stairs again and walk up and down the wheelchair ramp we had installed. I can’t walk the ramp or the stairs with my walker, so doing that would mean I’d have to use a cane, which I do have but haven’t used in months. I need to have better balance and more stamina before I can even try that.

But I can write. So I am.

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Mental Health

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What Won’t Work

Actor/comedian Stephen Fry discovered at age 37 that he “had a diagnosis that explains the massive highs and miserable lows I’ve lived with all my life.” It was, of course, bipolar disorder. In documentaries, podcasts, and books, he has talked very openly about his condition, spreading the word about stigma and the necessity of getting help.

Fry once said, “You can’t reason yourself back into cheerfulness any more than you can reason yourself into an extra six inches of height.” And he’s right. If one could, I would have done so. With years of debate behind me and an extensive knowledge of rhetorical fallacies, I can argue nearly any proposition into the ground. I should have been able to reason my way out of depression.

But no.

Fry was right. There’s no way to reason cheerfulness into your life. Emotions are not so easily controllable, especially if you have bipolar disorder or another mental illness.

Nor can you reason yourself into having thicker skin. Throughout my youth, I was described as “too sensitive.” I was genuinely puzzled. I had no idea how to make my skin thicker (and it was never explained to me how such a thing could be done). It took a long time and many life lessons and mistakes to make any progress at all.

There are other things that won’t make you mentally well, either. Expecting the first medication you try to be the cure is unrealistic. It can take a long time (in my case, years) before a medication or even a combination of medications will ease your suffering. And if you can’t work out a medication regimen that works, other treatments such as ECT, TMS, EMDR, or ketamine therapy are not guaranteed to work, or at least not completely. If you go into those kinds of therapy expecting a complete cure, you may be disappointed.

Trying to wait it out or tough it out is likewise ineffective. Again, this is a strategy I have tried. I used to believe that my depressive episodes would abate if only I waited through them until they went away naturally. Eventually, my mood might improve slightly, but that was due to another mood cycle kicking in. Naturally, depression was still there, waiting for me to fall back into it.

I know this may be controversial to say, but religion won’t cure mental illness, either. Having a supportive religious community around you can be an asset—if you happen to find a church, synagogue, mosque, or other community that treats people with mental illness in a caring way. Prayer and sacred music can be a great adjunct to other treatments, but by themselves, they’re not a cure.

Exercise and yoga are not cures. They are also great adjuncts to other treatments. They can increase your number of spoons—if you have enough spoons to do them. But if someone with bipolar disorder or depression can’t manage to get out of bed, how are they going to avail themselves of the benefits?

Likewise nature. It’s a great way to lift your spirits to walk among spring flowers or autumn leaves or to plant a vegetable garden. But again, you have to be at a certain level of recovery to be able to do these things.

Changes in your physical circumstances may lighten your mood for a while, but they aren’t a cure. My mother used to believe that if only I got a better job, my depression would lift. And it did, but only for a little while. It certainly didn’t cure me. There were plenty of things about the job and about my brain that brought the depression roaring back.

So, what are we left with? Therapy and meds, and other medical treatments such as ECT, TMS, and maybe ketamine or other novel medications. One can hope that science will discover better ways, like fMRI, that can determine which treatments will be more effective. But it’s far from clear how soon that will be and when they will be available to the average person.

So, when is your reason an asset? When you’re deciding which treatment and which adjuncts are right (or possible) for you. For example, I had to think long and hard—and do extensive research—on whether I should try ECT.

I’m not a doctor, and Your Mileage May Vary, but for now, all I can recommend is to keep on keeping on with what we know can work. There’s no guarantee that these options will work, at least not for everyone. But they’re the best options we have.

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A Bad Decision? Or Something Else?

I’ve been beating myself up for years. Feeling blame and shame. Not just for years, really—literally for decades. That’s a long time to carry the weight of those feelings.

I was in college, when many people make bad decisions as a function of venturing into a less restricted, more adult life. I certainly made my share of bad decisions.

I wrote papers the night before they were due and didn’t make a second draft. I skipped reading Moby Dick, even though it was on the syllabus for the course. I took Russian instead of Japanese simply because it was offered later in the morning, and I wanted to sleep in.

I switched from being a linguistics major because I thought there were no jobs in it, despite not researching the field or asking my advisor. I floundered, considering hotel management and landscape architecture for no particular reason.

Then there was the worst decision I ever made, the one that has haunted me all these years. I met a man—we’ll call him Steve—and went home with him that same night. A few months later, I moved in with him. This led to a year of gaslighting, depression, and more bad decisions about prescription drugs.

So, how can I explain my bad decisions? Some were simply the kind of decisions that a person out on their own for the first time makes. These don’t affect me the way the relationship with Steve did. Steve told my parents about our relationship instead of letting me do it in my own time, in my own way. That soured my interactions with them for quite a while.

Why did I behave the way I did? An avowed feminist, I let this man take over my life. I put up with emotional abuse for almost a year. I denied that I was mad at him for all I’d been through. I put all the burden of blame and shame on myself. And there it sat for decades. I had flashbacks and bad dreams. I had difficulty with further relationships.

Then, recently, a new idea came to me. At the time when all this happened, I knew I was depressed. I had never heard of bipolar disorder, much less been diagnosed with it. Now that I do know and have been diagnosed (and seen therapists and been properly medicated), my disorder has still leaned largely toward the depressive side. I do remember having hypomanic jags in which I spent too much, and a larger one when I got wrapped up in writing and tried to market a novel to 100 agents and publishers.

But the one aspect of bipolar disorder I never considered was hypersexuality. The idea that could be the reason I dove into the relationship with Steve so quickly and so deeply was a revelation to me. I hadn’t had any lightning-quick sexual encounters until then. I hadn’t thrown myself into them so wholly and so destructively.

Of course, I can’t blame hypersexuality for the whole situation. I did what I did, and I chose to do it at the time. That’s on me.

But the decades of shame and blame? Now that I know what hypersexuality is and what it feels like, I don’t have to carry that burden with confusion, devastated by what happened, and wondering why it all happened. I can see that I have carried those feelings with me for too long. I can perhaps lay down that burden, understand why it might have happened, and move on.

I have made plenty of bad decisions, but I don’t have to cling to one of them and beat myself up for it. Perhaps, with this new insight, I can at last move on, chalking it up to a bad decision under the influence of hypomania rather than a lifelong journey of guilt.

Perhaps, now that I understand how hypersexuality may have played a part, I can forgive myself.

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I’m Not Fragile

TW: Suicidal Ideation

When my husband and I were looking for a new house, we checked out various options. I found a house I liked, but it was too far from the businesses and services we used. Besides, it had a water tower in the backyard (which I was hoping Dan wouldn’t notice).

Then Dan found a beyond-fixer-upper that was crumbling into pieces. He looked at it as a challenge. I told him that if I had to live in it for more than a month, I would be compelled to commit suicide. To this day, I’m not sure whether I was serious.

At last, we found just the right house. Three bedrooms, two of which would be turned into studies. Over an acre of ground with many trees. It was a little more than we could afford, but we decided that this was our dream home.

It also had a small creek running through the property—more like a run-off, really. Dan’s mom tried to talk us out of buying the house. She had been through a flood many years earlier and feared that the tiny creek could possibly get out of control and destroy our house as hers had been.

“Besides,” she said, “Think of Janet. She’s fragile.”

By “fragile,” it was clear she meant my mental health was sometimes shaky, or beyond shaky.

I had made no secret of my bipolar disorder. At first, Mom Reily didn’t “believe” in mental illness, but eventually she admitted that there was something wrong with my brain. But it pissed me off that she used my mental condition to try to influence our choice of houses. However fragile I might be, there was no way that a tiny creek could break me.

I was not that fragile.

Nor was I fragile when our dream home was taken out by a tornado. I survived it, though I was on the upper story when the roof came off. I dealt with the insurance company, the motels, the rental property, our finances, and many of the other details.

I wasn’t fragile then.

Of course, there were times when my mental condition was fragile. There was the time when I was overwhelmed by three full years of a depressive episode, unable to do anything, from self-care to reading. And there was the times when suicide crossed my mind. Sometimes, it was idly wondering the plane I was on might crash (passive suicidal ideation) or if a fall from the balcony I was on would kill me.

Then there was the time I had active suicidal ideation. I had made a plan and everything. But I dithered so long over how, when, and where that the feeling passed, and I didn’t follow through. I didn’t tell anyone for decades, but then I told Dan.

So, have I been fragile? Yes.

But those were all times when there was something wrong inside my head. Flooding and tornados didn’t break me. The times I was fragile were all things that happened because of SMI, not purely physical circumstances.

Now—I’m not broken. I’m not even fragile. Years of therapy, years of meds, years of not experiencing floods and tornados, and years of supportive love from Dan have made me not fragile, but strong at the broken places.

I don’t fear the future. I’m not fragile anymore.

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Mental Health

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My Two Diagnoses

For all my childhood, I assumed I had depression, though I didn’t know that it was a psychiatric diagnosis. I was always a moody child, given to bursting into tears at the slightest provocation.

My first really major depressive meltdown came when I was humiliated by another child at a birthday party. I ran home, curled up in a beanbag chair, and sobbed for days. The only thing that snapped me out of it was the fact that my mother was being hurt by it too. She was crying too and had no idea what to do about my emotional implosion. At that point, I went down the street and yelled at the girl who had instigated the incident. (I suppose this could have been bipolar rage. I was pretty incoherent.)

I still remember this event as clearly as when it happened.

Another time, some friends were making fun of the way I laughed. Without saying a word, I got in my car and drove home, removing myself from what was distressing me. They followed me home and apologized. Then, I practiced laughing until I came up with something more acceptable. I think I accomplished it, though who really knows?

In my college years, I spiraled further. I was prescribed benzos for a TMJ problem, and I was in such a bad emotional place that I supplemented them with wine. There was some risky sexual behavior, too. It was the first time I recognized that I had a hypomanic episode. After I got out of the situation, I stopped relying on the benzos. (Actually, I had first experienced benzos in my junior high school years, when they were prescribed for an uncontrollable tic.)

Eventually, I went into therapy where I was diagnosed, as I expected, with depression. I continued that way for years, being prescribed various medications but still having symptoms.

Finally, I went to a new psychiatrist who, after some time, said he thought I had bipolar disorder. Eventually, we found a drug regimen that worked to alleviate my symptoms to an acceptable point.

I was still having symptoms, though, before the right cocktail was achieved. I was unable to work, get out of bed, or do much of anything, unhappy all the time. I applied for disability—and didn’t get it. When I got my file from Dr. R., I saw that my diagnosis was actually both bipolar and anxiety.

That threw me for a while. But looking backward and forward, I realize that he was right. I had anxiety episodes when I was a kid, usually regarding finding and keeping friends. I was terrified when my high school counselor suggested therapy. (I declined.) I panicked when it looked like I would have to go to community college instead of a four-year school, which I had always assumed was in my future. When I did get to that college, I had a mixture of the depression and anxiety, and took a year off to work and reset my brain.

Now, years later, my bipolar disorder is largely under control. But the anxiety haunts me to this day. I am anxious about family finances (which I am in charge of). Many nights my brain won’t shut up and I can’t sleep. (Sometimes it won’t shut up about the unfortunate episodes in my past.) I had massive anxiety recently regarding a trip to Florida.

So, I think Dr. R. was right when he diagnosed me with bipolar and anxiety. One has been tamed, but the other lingers. I am now working with Dr. G. to help me alleviate the anxiety without letting the bipolar kick up again. It’s a delicate balance.

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Mental Health

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