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Bipolar Road Signs: Navigating the Road Ahead

"Sometimes I think that a hundred dollar haircut is all that's standing between me and a fourteen day hold." – Terri CheneyIn Terri Cheney's 2008 New York Times Best Selling memoir, she writes evocatively of an aspect of bipolar illness that people with other mental illnesses-clinical depression, borderline personality disorder, schizophrenia, and others-may relate to.

In the quote above she's talking specifically about grooming. Although a hundred dollar haircut might be a bit out of most people's budget for a trim, nothing can stand in the way of a primp and preen when we're feeling good, manic-level good. It's a funny sentence, but an interesting insight. It holds a truth worth examining: there are things we do, ways we behave, differences in our appearance-some of them even subtle, believe it or not-that could stand as lighthouse beacons on the horizon for those who love us, and even for ourselves should we choose to acknowledge the changes in our mood which signal the shifts bipolar illness inevitably manufactures in our brain chemistry and in our lives.

"Bipolar" is a misleading word, just like "manic-depression" was when we used to call it that. It assumes there are two poles or two moods from which we're operating at any given time, but as is always the case, the truth is more complex. Our moods occur across a spectrum. What is different about them for people with bipolar illness is their intensity. At times for us, mood is a demand upon our psyche, rather than a filter through which we experience emotion or understanding. Although we experience "normal," "sane" stretches of time and mood, those extremes of mood that descend upon us tax our very being, as well as our relationships, our jobs, and sometimes our willingness to participate in them.

The Expressway: Impending Mania

There are layers to mania, and different ways it can manifest. There is hypomania, that not-quite-a-full-tank of mania that is the only time perhaps that being bipolar feels good. In hypomania, we are intensely productive, charismatic, "on," happy even. We can concentrate and produce and think logically and creatively. So many of us are brilliant, and hypomania makes us all the more so.

When hypomania is ignited, we look our best. We glow. Maybe we talk a bit much but it's guaranteed that everything we say is charming, connected, interesting. Smart. We're wearing our best outfit. Our shoes are probably new. Our hair is washed and styled. When we shake hands, we use both hands, grasping the other person's hand in both of ours, looking them earnestly in the eyes. We pay the check at dinner; wouldn't have it any other way. We're generous, gregarious, funny, polite.

But then…

Mania hits. We drive too fast. We spend the rent money on something unnecessary like a fad diet supplement system even though the reviews were sketchy and the science non-existent. We send an email to our boss with blatant innuendo-yes, even innuendo can be blatant. We wear anything that shows a little skin. A lot of skin. We're dropping weight, not because of the supplements but because we never eat when we're manic. And we don't sleep. We're an 8 cylinder turbo diesel roadster with bad brakes. We're careening and when we finally stop, it's because the road ahead was painted on a brick wall called …

Depression: Falling Rocks Ahead

When depression hits, it arrives out of nowhere. It's a falling rock road sign we don't see until we've rounded a sharp curve and suddenly the mountain is on top of us, pinning us to earth. We cannot move and our desire to try tumbled away from us like the earthface from the mountainside. We stop caring about our appearance; hygiene takes too much energy. If we have no choice but to drag ourselves out of bed, force ourselves to stand under the showerhead, it's a monumental effort. Our coworkers comment on how tired we look; they ask us if we're not feeling well. We're feeling horrible, but how can we explain it? Our dull eyes look puffy, our hair limp. It's not like us to call in sick from work, but we do, even though we're not technically sick.

Our natural optimism has escaped us. We are doomsday seers. Everything we think (we have nothing to say) is covered in a layer of fatalism. Nothing is good; nothing has ever been good; nothing will ever be good. There is no reason to exist.

The Mixed State: Bridge is Out

Our relationships suffer in the high times and the low. How can we explain to our loved ones that depression zaps us of the ability to feel anything at all? It's killing us; we're not trying to do it to them. And mania, true mania, can ravage our relationships irreparably. We spend through our savings; we fly away, hypersexually charged, no thought to consequences; we imagine we're invincible until we wake up bruised.

But then the mixed state arrives: depression pours itself into the beaker of our brain chemistry and mania decants itself on top. It's a witches' brew. The terrible agitation, the intense irritability, the I'm going to rip my skin off! We're not so nice to bystanders: grocery clerks, customer service reps, employees. We're hardest on ourselves and our loved ones during mixed states. In these times, we're least understood.

In every mood extreme of bipolar illness, many of us have turned to alcohol or drugs. Years go by and we develop a tolerance which requires us to use more to help us feel less agitated, less bleak. To help us feel numb so that we can escape the greater numbness, to help us feel nothing which is better than the pinpricks happening inside our pores, the clanging in our heads. Our lovers and our family members decide we're addicts and alcoholics and maybe we are. But the problem-the reason-happened long before any addiction. We've just been trying to cope.

Rest Stop Ahead

Bipolar illness sounds like a hard road, and it is. You already know this because it's the road you've been traveling down since you were 30, or 22, or 16, or perhaps even 10. There's no going in with a clean-up crew and sugar coating it. Let's not pretend. Put down the floral print brochure and the light handed article that holds you at a distance and talks at you in saccharine language. You are the primary authority on your own sanity.

But what you have read and what you have been told by people who have the background to know is true: bipolar illness can be managed. It has the distinction of being one of the most treatable mental illnesses there is. That's nothing to cough at. The problem is this (pay close attention): because it is so treatable, and because people with bipolar tend to miss the hypomanic stage, many of them stop their treatment. This is not good. This disorder has a very high mortality rate. Up to 20 percent of us commit suicide and many more attempt. This makes bipolar illness the second deadliest mental illness to have.

But back to the good news: you can be well. You can manage your disorder and you can be sane and healthy and well. You do not have to live at the precarious, unpredictable, taxing apexes or the soul-sucking, flat lining lowermost of the well of despair. You can stabilize and level your moods and from there, begin to amend every other part of your life. There is, in fact, meaning, you'll discover. And goodness in a level life.

Posted in Bipolar

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