A couple of weeks ago, I had an initial assessment with a psychologist from my Community Mental Health Team. The purpose of the session was to look at how talking therapies might be of benefit to me in helping me manage my bipolar disorder. We started by talking about what had been happening in this most recent episode, and I described its roots and the treatment tried so far. I explained that I was taking my medication as directed – I’m always a very well-behaved patient in that regard! – but was frustrated by what I felt was a lack of progress and yearned for my life to be the way it was before this episode. I told the psychologist that a few weeks previously I had reached a point where I felt that I could not go on, if my life meant now consisted of moving between “normal” weeks and weeks of deep depression. With my highs largely eradicated since I started lithium, I felt that I had been left with the worst of both worlds – the unpredictability, changeability and depressions of bipolar, without the glorious feelings of the highs. Although I know that hypomanias are pathological and run the risk that I will develope full-blown mania, the thought of never experiencing one again makes me feel scared and bereft. At the end of the session the psychologist said to me, “So, it seems to me that one of things you would like help with in therapy is coming to terms with this diagnosis of bipolar disorder.”
I was taken aback by this. Not come to terms with my diagnosis? Me? What could she mean? It was true that when first given a diagnosis of bipolar as a 20 year old student I chose not to identify with it, despite feeling on some level that it was right (based on my reading of abnormal psychology books from the university library, anyway). I certainly didn’t want to engage with the treatment plan, because the idea of being on lithium freaked me out. So I never took the prescription, and never went back to see a psychiatrist. Over the next 6 years, I had several periods that were very clearly bipolar “highs” featuring decreased need for sleep, disinhibition, and elation or agitation, either immediately preceded or immediately followed a depression. And yet, bizarrely, at no point during did I think to myself, “Hmm, remember those abnormal psychology textbooks? I wonder if that psychiatrist back in 1995 days was right?” For about 8 years prior to the beginnings of this episode I was in remission, and was almost entirely stable apart from very minor mood fluctuations. I was maintained by a continuous dose of an antidepressant (further evidence in my mind that I did not have bipolar, because I was well despite not being on a mood stabiliser). In fact, during that period of remission I began to feel that there was nothing much wrong with me at all, and that I had “recovered”. So I agreed it would be fair to say that in the past I had been in denial about my bipolarity. But this time around was different, surely? Since getting the diagnosis (again) at the start of May 2011, I have been blogging about my experiences and about bipolar issues in general; I have shared my diagnosis with family, friends and employers; and even have a public Twitter name of @BipolarBlogger. Could I be any more overtly associated with my diagnosis?
I thought about this on the way home and all through the evening. Is being associated with something the same having accepted it? Maybe not. It seems to me that I have accepted what I see as the “positive” parts of the diagnosis: an explanation for the symptoms I experience, a connection with other people with similar symptoms, a treatment plan which aims to alleviate my mood swings. But clearly it is also true that I am not reconciled to many aspects of being diagnosed bipolar. I don’t like the fact that in order to live a more normal life, I probably have to give up my hypomanias (see how I typed “probably” there, in case there might be a way I can still hang onto them). I am struggling to cope with the fact that it is taking a long time to find a treatment regimen that gives me the sort of stability I previously enjoyed, even though I know perfectly well that it took several years to hit upon that very treatment. I don’t know how to come to terms with the unpredictability of my life as it is at present, nor the side effects of the drugs. And above all, I have not come to terms with the fact that maybe some of these unpleasant facts are part of my life in the long term now, because this is part of what it means to be bipolar.
Don’t you just hate it when therapists are right?