I recently had cause to look back at the first ever blog post I wrote about my mental health. It’s called A Tale of Two Beasts, and it’s an exploration of the interplay between the feelings of anxiety and depression I was struggling with in April 2011. I wrote it just at the point that my symptoms had just forced me to go off sick (it’s probably for the best I didn’t know then that I would never return to my job; I couldn’t have dealt with that information) while I was waiting to see a psychiatrist. You can read the piece yourself if you’re so inclined, but the basic premise was that I was experiencing anxiety as a small, busy, nibbling beast that wore me down with its relentless energy, creating space for the big beast (dark, heavy, lumbering depression) to shuffle in and take over my life.
Like many people who’ve been in the mental health system a while, I’ve collected a few labels along the way. While I’ve reached a point where the bipolar diagnosis feels right (it accounts for the episodic nature of my emotional difficulties, and for the periods of months or even years when I have just felt “normal”, as well as connecting me with people with broadly similar experiences) I do have residual, nagging question about my diagnosis.
I would like to say that the term “bipolar disorder” reflects the diversity of the mood states I experience, but I’m not totally sure that’s true. My previous diagnosis of major depression, clinical anxiety and borderline personality disorder traits was arrived at in 2003. It had a lot of flaws, particularly the borderline part, which I felt failed to explain why my emotional problems came and went in distinct episodes. What was very useful, however, was to have clinical anxiety teased out of the mix as a separate strand. That in turn allowed a greater focus on my dissociative symptoms, which had become more and more of a problem over since 2000, culminating in a new antidepressant selected to better target the depersonalization and derealisation.
Fast forward ten years, and I’m finally coming out of the episode that’s lasted since 2010. During that time I’ve experienced bipolar irritation, bipolar anger, depression, elation, and mixed moods. I am very clear that there have been times when I am in a state of “bipolar anxiety/panic” – my hypomania can often be a state of anxious agitation, and panic is always an element in my mixed mood states.
But I also feel strongly that there is a kind of underlying, baseline anxiety that is actually nothing to do with bipolar. It’s the kind of anxiety I have when I am otherwise 100% well, even when I have been otherwise stable for years. This “little beast” sort of anxiety leads me to lie awake at night worrying about work or my children or money or a flu pandemic. It causes me to fearful of making phone calls and finding unfamiliar addresses. These things just go on being part of my experience, no matter what the emotional “weather”.
In the course of writing my memoir I have done a lot of reading, using what I have learned to look for clues to the nature and onset of bipolar in my childhood. I’ve been fascinated to discover that extreme anxiety, particularly separation anxiety, is often a feature in children who go on to develop bipolar in later childhood or adolescence. I was the kind of child who worried about everything, to the extent that I was too emotionally paralysed by anxiety to do many of the things that other children enjoyed. I wouldn’t go to a birthday party unless my mum could wait there with me. I refused pointblank to stay anywhere without my parents; I simply couldn’t understand what was supposed to be fun about a sleepover. Even at home with my parents I was still scared, because I had trouble believing they knew how to keep a child safe. I was scared of dogs, spiders, and the sound of the wind in the trees. I didn’t want to sit on a donkey at the seaside or a take a turn on a fairground ride. I was variously worried that I would get kidnapped or murdered, or die in a car crash. My parents constantly tried to make the world a better place, but rather than seeing hope in their involvement in the peace, all I saw was the constant threat of nuclear annihilation. Oh, I must have been such fun to be around!
I can’t tell you how early the anxiety started, but I do remember panicking about my first full time day at nursery school because I didn’t know how I would cope without my comfort blanket. In the end, I allowed my mum to cut off a small corner so I could carry a piece of it with me in the pocket of my pinafore dress, but it wasn’t the same (it just didn’t smell right). But I do know anxiety has been a constant presence since those pre-school days. Now that my moods have virtually stabilized – give or take a little manageable hypomania – the anxiety remains. Anxiety feels a part of me, whereas hypo/mania and depression are things happen to me. So is anxiety part of my bipolar? A completely separate disorder? Or a personality trait?
I know friends who have a diagnosis of bipolar disorder with an additional diagnosis of clinical anxiety and I was all set to discuss this possibility with my psychiatrist when I heard this interesting podcast from the Royal College of Psychiatrists. Dr. Sam Nayrouz and Professor Allan Young confirm the view that many children have one anxiety disorder or another as a kind of precursor to developing bipolar disorder a few years later. They are also very clear, however, that anxiety is part and parcel of a bipolar diagnosis, and that anxiety sometimes persists even after all other bipolar symptoms have receded.
Nayrouz and Young, or indeed my own Consultant, might well ask how it would benefit me to add an anxiety strand to my diagnosis. It’s unlikely, from their point of view, that it would change my drug regimen of antipsychotics and lithium, although I suppose there is the possibility that I could access more targeted CBT to address my worry and panic. I don’t really have an answer to this, other than to say that though the shuffling beast of depression and the wild, white stallion of a hypo/mania are fading into the distance, the busy little beast is still here, whispering in my ear.