TW: verbal, emotional, & sexual abuse; transphobia; description of manic symptoms

I should not have allowed Ron to drive home at 2am two weeks ago. I should have talked zir into going to the hospital.

I just … I’ve read about how traumatic mental health hospitalization can be. I volunteered on a locked adult psych ward – and I was terrified they’d figure out I should be there as a patient and prevent me from leaving. Ron talked about how horrible being hospitalized was, I’m not sure if that was before or since the last time I wrote about zir. On a personal level I’m generally inclined against seeking medical help – especially going to the hospital – unless absolutely necessary, like life or death … But I shouldn’t have fallen back on that. I risked Ron’s life, allowed zir to go untreated for another week – during which zir symptoms got worse and zir behavior became a risk to zirself and others – and allowed it to get to the point where ze was involuntarily committed (by someone else).

Worse, I subjected myself to nearly 48 hours of being ranted at, manipulated, and abused. I feel like it’s set me back at least a year, maybe two, in terms of my own mental health. I’ve spent the past week on an emotional roller coaster, replaying the most painful moments over again in my mind, and debating whether I have any right to describe someone else’s symptoms on my blog. Well, those symptoms interacted with my mental health issues to make it so there are times when I feel dead inside. I’m having self-harm thoughts and urges again. That’s mine to write about!

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Compassion / Pay It Forward

TW: mention of suicidal ideation

Ron had two really bad days in a row, and didn’t sleep in between. Ze told me ze was suicidal. On the first day I took time from my visit with Banji to have an extended phone conversation with Ron, anything to keep zir connected. On the second day I drove for five hours, successfully chaired a 90-minute meeting, reconnected with Fox after 5 days apart, then welcomed Ron into our home at 10:30pm. We decided to hang out in the back yard.

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Hypomanic and Depressed at the Same Time

I read an article today and now my world makes so much more sense. In a Depression Bipolar Support Alliance (DBSA) “Ask the Doc” article, Dr. Mark Bauer, MD states that:

“[T]he most common mood state in bipolar disorder is a mixture of hypomanic/manic and depressed symptoms. In fact, the classic picture of bipolar disorder having a course alternating between the poles of high and low moods is an over-simplification.”

He goes on to explain mania and hypomania more clearly, basically describing them as hyperactivation – feeling “sped up” and driven. This can feel good (e.g. grandiosity), bad (e.g. irritability), and everywhere in between. In other words, mood and activation level are two different things.

Ergo, we can think of bipolar disorder as

“a condition of recurring depressive periods punctuated by periods of hyperactivation – and sometimes these periods of hyperactivation alternate with slowed down, depressed periods, but at other times they overlap.”

That. Is. My. Life. It’s very rare for me to experience a period of time with no depressive symptoms; at best my symptoms become few and mild enough that I don’t meet the criteria for clinical depression for a couple days to a few weeks. But periods of hyperactivation… just look through my blog and you’ll see my posts about “I’m going to do this new thing that will change the world,” staying up all night composing, “now I’m getting better and I’m mad at Fox all the time,” and most recently “Let’s Play Skyrim!”

I usually feel better during my periods of hyperactivation because 1) I have energy to do things and 2) I’m hyper-focused on something that’s meaningful to me, at least while the hyperactivation lasts. Sometimes I don’t feel so good because I want to Do All The Things!!! but I can’t focus on one thing to do, so my mind is a jumbled mess. I’ve also tried to be a part of too many different groups at once, which invariably results in me feeling overwhelmed, backing out, feeling guilty, and my depression symptoms becoming more severe. As far as I can tell, all of my periods of hyperactivation have occurred at times when I also met the criteria for mild depression. (Possibly also moderate depression.) In other words, I’ve never had a discrete hypomanic or manic episode.

I try not to put too much importance on labels; what’s really important is that the needs of the person with a mental health issue are being met. But having a label creates a container for my experience; I can understand it and talk to other people about it and know I’m not the only one who’s had that experience. Finding labels that accurately describe my experiences helps me feel safe. I obviously can’t diagnose myself, but the label “bipolar disorder” seems to become more accurate the more I learn about the experiences it’s intended to describe.

I know I’ve been “depressed” lately because I’ve been feeling sad and/or grumpy, isolating, having trouble eating full meals, apologizing for my existence, and thinking “I want to die” when I’m tired. I feel like it’s only a matter of time before my world starts unraveling (again): I worry about Fox’s safety, our rats’ health, my own health, the house burning down, etc. Calling these experiences “depression” helps me separate a bit from them, accept them, and engage in self-care.

Diagnosis and Identity

A trusted friend who has bipolar and works in a mental health setting pulled me aside the other day; he said he’s observed some possible symptoms of mania in my behavior. He presented the information as something that might help explain some of what I’m going through, and more importantly as a tool I can use in my creative endeavors. Use the unbridled, chaotic energy to create; edit when the mind is calmer. I don’t think I want to edit when I’m depressed because then I’ll probably get rid of a lot of good material, but I digress.

To be honest I’ve been wondering about the possibility of there being a manic – or, more likely, hypomanic – component to my… madness. I do seem to have times when the depression lifts – just enough that I think I’m starting to get better, but not enough to say I’m “in remission” or “have recovered.” These times are often accompanied by a whirlwind of energy in which I become engulfed in a new project – which I tend to abandon completely when the next wave of depression hits.

I never really pursued the possibility of mania/hypomania being part of my madness for a few reasons:

  • I thought it required elevated mood; to the degree that my mood becomes “elevated” it would probably fall within the range of “normal” non-depressed emotions.
  • Questions on screening tools that explore the possibility of mania/hypomania tend to begin with “a period when you were not yourself and…” I’m always myself.
  • I’m not comfortable talking about some of my experiences with mental health professionals because I don’t want them to pathologize experiences I consider(ed) to be spiritually meaningful.
    • Some of the voices in my head may become abusive, but others can be supportive. It might be different, but I often find it adaptive. I’d be lonely if they all went away.

But now I’m thinking this is a possibility worth looking into. I pulled out the DSM-IV-TR and reviewed the relevant symptoms with Fox. (We don’t have a copy of the DSM-5 and I’m inclined to keep it that way, considering the concerns people have raised about it.)

The DSM-IV-TR clarifies that the mood in mania/hypomania can be elevated, expansive (?), or irritable. We’ve both noticed that I seem to have some of the additional symptoms: (3) more talkative than usual or pressure to keep talking, (4) flight of ideas or subjective experience that thoughts are racing, (5) distractibility, (6) increase in goal-directed activity. Additionally, it is possible for depressive symptoms to be present at the same time as manic/hypomanic symptoms. Hypomanic episodes can be as short as 4 days and do not require there to be marked impairment in functioning (e.g. taking huge risks) to be diagnosed.

I’m not really in any rush to ask a professional to put a stigmatized label on me, but I do think this is important. It can help me understand myself and navigate my life and experiences. Awareness of it might help me find useful ways to channel the energy when it hits and possibly even cope better when it dissipates.

If I pursue treatment, particularly medication, it changes what I need; Fox said that medications for bipolar disorders are better understood and tend to be more effective than those available for unipolar depression. I’d need to do some research, but I do feel more hopeful about finding something that works for me (preferably with minimal side effects / other health risks).

Finally, it’s very important to me to represent myself as accurately as I can on this blog. One of my goals is to give people who have never experienced madness / mental illness an insider’s perspective of what it’s like (for me). If I say I have one disorder but I “really” have something else, I’m misrepresenting the first disorder and doing a disservice to everyone involved.

For now I just want readers to know that I’m not sure what my diagnosis should be. At the end of the day we’re all people with dynamic issues and behaviors that don’t really fit into neat categories.