When the psychiatrist first said the words, I couldn’t get my head around them.
It’s not that the diagnosis was a surprise, exactly. I’d considered it before. The mood swings have plagued me for nearly as long as I can remember. The elation and confidence that would carry me along but which I couldn’t seem to maintain for more than about a week before crashing. Each time the euphoria took hold, I would hope that it was the New Me, the happy me that so many blogs and self-help books assured me that I could unleash through nothing but my own willpower and maybe some dietary changes. Turns out, what I’d for so long pictured as a wave of euphoria carrying me along was actually the seat in a dunk tank upon which I was perched until the star pitcher came to the head of the line and plunged me back into depression.
But in both states, I was functional, if sometimes frankly unpleasant to be around. Weren’t people with bipolar disorder unable to function? Didn’t they need to be hospitalized? Didn’t they have hallucinations and delusions?
Apparently not. Or at least not necessarily.
My diagnosis was (is) Bipolar Disorder Type II, or BPII. After my psychiatrist answered my questions and sent a prescription for a mood stabilizer to the pharmacy of my choice, I went home and searched the Internet.
The NAMI site helped clear up some of my confusion, as did the information I learned from the NIMH site and an information page from American Family Physician. While in Bipolar I, the main problem is mania—which includes elevated mood (either happier or more irritable) accompanied by psychosis and/or delusions—and the depression is secondary (a depressive episode isn’t required for a diagnosis of Bipolar I), in Bipolar II, it’s the depression that’s the most troublesome symptom, punctuated by brief periods (4-7 days, usually) of hypomania. Hypomania doesn’t ramp one up to the degree that mania does, and it doesn’t involve psychosis. If you have symptoms of a bipolar disorder and you’ve had a psychotic episode, you’re generally diagnosed with Bipolar I. The hypomania wouldn’t be a problem at all for many people with BPII if it weren’t for the inevitable crash.
I have always blamed myself for the switch into depression. If I were more determined, had a more positive mindset, were a better person, I would be able to stay on top, not fall into that dunk tank. That blame itself could be a symptom of depression, but I have that thought even when I’m not depressed, even when I’m hypomanic or in the brief times when I’m in a neutral mood, whatever that is.
For years I’ve been in and out of therapy, talking to my primary care doctor about my depression and occasionally trying anti-depressants, which seemed to have side effects but didn’t really help ease my depression. That’s also a symptom of BPII. Unless someone with a bipolar disorder is on a mood stabilizer, anti-depressants either don’t work or send them into mania (although apparently there’s a lot of controversy about this). I guess I’m grateful that my primary care docs’ experimenting on me with the samples left by the last pharmaceutical rep to visit didn’t land me in the psych ward.
All of this time, no one ever suggested I see a psychiatrist, even when I described my mood swings to them. Then this January I had a mood swing that was so quick and so intense that it scared me into finally insisting upon seeing a psychiatrist. (Not that it was remotely that simple. More on the state of mental health care in the United States in a future post.)
Looking online, more pieces fell into place. My quick temper, my quirky sense of humor, my creativity, my goal-driven behavior, the way the codeine I got for my root canal and the Percocet I got when I had my wisdom teeth removed hyped me up before knocking me out—all of these go along with BPII.
So, unlike some people diagnosed with bipolar disorders, I’ve not had much trouble accepting the diagnosis. My biggest difficulty so far has been reconciling my own biases against mental illness with this diagnosis. More on that in my next post.