On Joining the Ranks of the “Seriously Mentally Ill”

In a previous life, I worked on clinical trials for bipolar depression. On clinical trials, actually, of the very drug I am now taking as a mood stabilizer. Is that irony or just coincidence? Alanis Morissette and I always have trouble telling the difference.

Working on those trials, the closest I got to working with actual patients was participating in training study sites to administer the symptom questionnaires to determine if patients met the psychological criteria for inclusion in the study. From that distance, I could safely feel pity for those patients but there was no need to think of them in any inclusive way. Although I didn’t think of it in so many words, I was secure in the knowledge that I was on the “sane” side of the equation.

After my bipolar II diagnosis, I quickly realized that I had divided the world of mental illness into two categories: the run-of-the-mill mentally ill and the crazy people. The run-of-the-mill mentally ill are those anyone could safely relate to. “I’m feeling a little OCD today,” one could say. Or, “After that movie I felt so depressed.” We say those things not really believing we have those conditions, but if we did, well, everyone’s a little OCD sometimes, right? It’s all a continuum, blah, blah, blah.

What about the “crazy people”? It turns out that in my unconscious categorizations, the only people who fall into the “crazy people” category are those with schizophrenia and bipolar disorder.* And here I was in the wrong category.

The day after I got my diagnosis, I volunteered to prepare and serve food at a community meal for the food insecure. Some of the people who attend those monthly meals are homeless or nearly so. Many of them suffer from mental illness.

As I handed out cookies with my gloved hands to people with difficulty making eye contact, people who had odd tics or who spoke too quickly or too loudly or in non sequiturs (or in quick, loud non sequiturs), I thought, “Are these my people now?”

As I walked down the street recently and observed a woman with bizarrely mismatched clothing having an animated conversation with herself (I checked for a cell phone and ear buds, but there were none), I wondered how far apart she and I really are. Why am I living in a suburban split-level and shopping at Whole Foods and she’s on the street?

I found a local support group for people with bipolar disorders and schizophrenia but balked at calling for more information. “I don’t want to be in a support group with a bunch of crazy people,” I thought before I caught myself.

Am I a crazy person?

By my pre-diagnosis categories, yes. I am a crazy person. I either need to reconcile myself to that label, or I need to shift my paradigm.

I’ve not decided on one course of action yet, but I suspect I’m leaning towards the paradigm shift. I’d already veered away from casual mentions of anxiety disorders and OCD because I already knew that any tendencies towards those behaviors most of us have don’t impact our lives nearly to the degree that they do for those who actually have those mental illnesses. But since my bipolar II diagnosis, I’ve begun to be more careful about how I use words that indicate a lack of sanity. Where I might have said, “This traffic is driving me crazy!” I now say, “I feel really annoyed by this traffic.” Where I used to say, “I went temporarily insane and bought the giant bag of potato chips,” I say, “It was inadvisable to buy chips at the warehouse store.”

I find myself making a big deal about the fact that bipolar II doesn’t involve psychosis. I feel bad about this. Not only is it just shifting the scale rather than shifting my paradigm, it feels unfair to those who have psychotic symptoms. They can’t help their psychoses and delusions any more than I can help my precipitous descent into depression. I suppose it can be unsettling to interact with someone who’s experiencing reality in a more fluid way than we’re accustomed to, but how confusing and scary must it be for those experiencing it? And then there’s the other thought that comes to mind: Would I know it if I were experiencing delusions or hallucinations? Based on interviews with people who experience psychotic symptoms, at least some of those who experience these symptoms recognize them as being thoughts that aren’t reflective of reality, but there also seems to be a point at which it’s difficult to determine the border between hallucination and reality.

And maybe that’s the scariest thing about this diagnosis and trying to reconcile my unexplored definitions of sanity and insanity. How do I really know which side of the line I’m on? Or is there really a line at all?

*I’m not the only one who focuses on schizophrenia and bipolar disorder as the dividing line between serious mental illness and other (presumably non-serious?) mental illness. Here’s an article from NIMH (the National Institute of Mental Health) about this terminology.