My psychiatrist has been increasing my mood stabilizer dose steadily since I began taking it almost four months ago. Each time I visit him, he asks me questions to gauge how well the medication is working for me. The questions are sometimes challenging for me to answer because the endpoint isn’t clear. Where am I aiming? The goal seems to be to have mood fluctuations within the normal range, but what is normal?
Within the past few weeks, I’m starting to be able to answer these questions.
The main reason I sought psychiatric help was the intense and uncontrollable rage that I would feel as my mood shifted from hypomania to depression (I apply those terms in retrospect. At the time, it was just the transition from “woo-hoo!” to “craptacular”). I have always felt profoundly embarrassed by these rages. When I would talk to other people, though, they would assure me that this was all normal. “Everyone gets angry sometimes,” they would say, and, “All moms yell at their kids when they’re being little shits.”
I tried to be comforted by this, but I suspected that what they were talking about was something different than what I was experiencing. I didn’t just yell when things were shitty, I yelled anytime. And I didn’t just yell, I screamed until my throat was raw. I stomped the floor so hard my foot hurt for three days afterward. In high school I bloodied my knuckles punching my bathroom wall. Four years ago I bought book repair materials to fix all of the bindings I broke throwing books against walls. I once broke the front of a front-loader washing machine throwing shelves across the room.
But I didn’t tell anyone this, or if I did, I presented it in such a way that it was easy to laugh off. People seemed unable to imagine a 5’2″ soft-spoken little woman hulking out in any significant way.
I didn’t tell anyone because this rage was my huge failure. I should be able to control this thing. All of the articles said so. They talked about all of the biochemical damage I was doing to my children by yelling at or even near them and offered simple solutions to keep me from yelling, like counting to ten or deep breathing or daily meditation.
But counting or breathing couldn’t stop the rage. The rage was like throwing up. I could hold it back for a while, but eventually it just came out, and the best I could do was to try to get out of the room before it happened. Sometimes I made it, and sometimes I raged all over the dining room or the garage or the hallway and on anyone who happened to be within screaming range.
I would get done with one of these rages and instead of feeling better, like I’d cleared everything out, I felt like shit. The sense of failure was debilitating. I wished I would lose my voice so I couldn’t scream. I fantasized about leaving my family in dozens of different ways because I was failing so comprehensively at being a wife and mother.
This month, though, as my dosage has been approaching the standard therapeutic range, I’ve noticed a change. I still get angry, but deep breaths and counting actually help keep it from becoming rage. It’s not like throwing up anymore. It’s more like a burp. “Oops, pardon me!” I say, and we move on with our lives.
The other change I’ve noticed is that I don’t really think about bipolar disorder so much anymore. I take my meds twice a day, I fill out my mood tracker every night before bed, but BPD isn’t on my mind constantly anymore. It’s still at the party, but it’s chilling on the couch rather than dancing on the tables. I don’t agonize over whom to tell or whom not to tell or what people will think of me if they found out. I knew of an alcoholic in recovery who explained that he only felt compelled to tell people about his alcoholism when he thought it would help them to hear about it. That seems like a workable model for my situation, too.
For years, I was doing all of the things I was supposed to do—I was in therapy, I was breathing and counting and meditating, I was consuming no sugar or alcohol, I was taking vitamin D and exercising and spending time outdoors and reducing stress—and I was still fucking it up. It must be me, I figured. Something was fundamentally wrong with me. And it turns out it was me, but not in the way I thought it was.
The BPDII diagnosis and the mood stabilizer just make it so the suggestions in the articles apply to me. I still have to work, but now I see real, measurable improvement for the work that I do, and that’s an immense relief.
So, maybe this is normal for me. I don’t know if my normal looks like anyone else’s, and I don’t know if it’s going to stick around, but it feels pretty good to me right now.