Bipolar disorder is a rather all or nothing term, which can, at times, be quite misleading. It implies that you are either delving the depths of misery or riding a wave of elation – or maybe entirely normal, if you take your treatment like a good patient. Except it quite frequently doesn’t work like that.
For me, the excesses of joy appear to be well controlled now by a mood stabiliser, which I suppose is good. I must admit to occasional fantasies about stopping it, but realistically immoderate bliss doesn’t always work out very well, and, at the very least, can make you appear a bit stupid. Embarrassment and misguided decisions can follow, and it can be life-threatening for some.
Conversely, my own experience has been that low mood is unfortunately a bit of an ongoing problem, for which I’m currently having maintenance ECT as well as nasty medication.
My question, though, is what should I expect? Firstly, what is normal, and why should I want it, especially if it’s decided for me? How can this ‘normal’ possibly be the same for all people, all cultures, all diversities, all ages? My expectation of it may well be quite different from yours. And what I feel is normal, or even good, for me, may not be what someone else thinks. I have had the dubious pleasure of being the subject of various psychiatrists over the years, and what makes them decide if I am depressed or high?
The last couple of years have been a bit rubbish for me, and if someone asks me, I’ll probably say that I have had a relapse of depression. I wish it was that simple. ECT has played with my memories, but I think I can remember a fair amount. But can I? What I remember feeling like doesn’t quite match with what my husband describes, and sometimes I wonder if my memories are in any way accurate. I don’t clearly remember feeling depressed – it’s almost more like a memory of a memory, which I then start to doubt. At worst, I wonder if I’m making it all up, or have a personality disorder. But why would I do that?
More recently, I’ve been thinking more about the moment I’m in just now. I don’t think it’s possible to recall severe depression, or indeed many changes in mood – all you have is the memory of it, and then the memory of that memory. This makes it very difficult to look back at one’s life with a mood disorder, as it is inevitably influenced by one’s current mood. I suppose it’s a bit like remembering being hot when you’re cold, or vice versa, but I think that’s slightly easier. Taking it a step further, there’s no way to prove that one’s memories are accurate – or even happened – but it gives you something to work with.
So for someone like me, with a diagnosis of a mood disorder, please remember that nothing is particularly reliable. You may have seen me depressed, euphoric, or, if you’re lucky, normal, but even this may have been manipulated by expectations – or treatment. Medications can sedate or elate, and, as a psychiatrist myself, I know that an established diagnosis can influence how one interprets a patient’s presentation, at least to some extent. Of course this isn’t always the case – someone presenting severely manic is unlikely to go unnoticed – but what will they later remember, given that their state then was completely different?
My memories of my moods and beliefs are quite muddled, whereas my husband copes with my illness – if that is what it is – by seeing it in a very black and white way. Either I’m well, or I’m ill. I think this can make it difficult for both of us, in that he is very caring when I’m ill, but finds the transition challenging. He remembers the last couple of years as periods of severe illness, which were treated with ECT, interspersed with periods when I was better, and back at work. For me, it’s much more murky, and remains so, maybe because I’m still having maintenance ECT. Neither of us can know if this works, but both of us fear the consequences if it does, and I stop it.
Work has also been difficult, which may be partly my own fault. Throughout my career, I’ve been determined to continue working, unless I really couldn’t, and reluctant to do less than others. I have worked less that fulltime, but then so would lots of people who had three children, and I’ve always tended to try to do extra. I’ve realised in the last couple of years that this may not be sensible, but I’m not very good at explaining my illness and its difficulties – largely because I’ve always wanted to hide it, or prove I was just as good as others without such potentially stigmatising labels.
I don’t expect any answers to all this; the more I think about it, the more confused I get. It’s not like I’m ever going to remember the definitive version, but that doesn’t mean my thoughts don’t count. No-one can be sure they’re right, not my husband or any of the psychiatrists I’ve seen; and none of us can ever claim that their memories trump those of everyone else.
Meanwhile, I am making a new effort, one that I’ve always avoided where possible. Exercise is probably good for me, and, despite my dubious memories, I’m fairly confident that I haven’t done much over the years. A brief foray into running left me with sciatica, but – so far – the indoor exercise bike is proving a success. Probably because you don’t have to go anywhere and it doesn’t take much time.
And ultimately, whatever my opinions and my memories tell me, I need to do things to keep well, and I am making that effort – exercise, music, literature, sensible diet – and even work. And if these are insufficient, then I must swallow my pride and listen to the views of others, however unpalatable they may seem.