Bipolar Disorder and Stigma
I feel as if I never fully understood the effects of stigma until I was diagnosed with bipolar disorder. That’s not to say I didn’t experience stigma when my diagnosis was major depressive disorder, or that I don’t face stigma when it comes to my anxiety disorders, but the nature of my relationship to my illness changed when my label shifted from something people dismissed, trivialized and misunderstood to something that—on top of all the rest—people were legitimately afraid of. Yet the irony is that the recognition of my symptoms for what they were was the only means by which they could be properly addressed. It was the only means by which I could finally get proper treatment, and therefore become less “dangerous.”
To give you some background, I’ve had problems with my mental health from the time I was around twelve or thirteen years old. For a while it was easy to dismiss my moodiness as mere adolescent angst, but eventually it became clear that my general malaise and frequent outbursts of overwhelming sadness were not just normal parts of growing up. I began seeing a therapist and a psychiatrist shortly thereafter. I often drank to excess to lift my mood and feel less debilitating self-consciousness around other people. I began to occasionally explode in anger at my parents and others, which looking back was a definite early warning signal, but I just thought of it as a consequence of my drunkenness.
Getting through schoolwork was a struggle, fraught with anxiety attacks and crying fits, but I managed to keep my grades from suffering. Eventually, by the time I graduated, I thought I had a firm grip on my psychological issues and my abuse of alcohol. No longer mired in self-loathing I felt confident in myself and comfortable enough with my story that I had no problem sharing it. I was victorious and eager to begin my next chapter.
All of that changed when I arrived at college. It was the first major change I’d had to cope with in my life: I had lived in the same apartment since I was born, and the same school from kindergarten onwards. I quickly realized my newfound self-assuredness was predicated on having found a niche of friends to rely on, and without them in the same city as me I felt lost. Then I came down with mononucleosis. I was exhausted at all times, unable to focus on anything, failing classes for the first time ever, totally unable to enjoy anything I had once found fulfillment in, terrified of being judged by all my new classmates, and because I had no idea I was physically sick, I thought that all of these things were personal failings on my part. When I was eventually tested for the disease two months after I began feeling its symptoms, the damage to my ego had already been done.
I moved back home, and there made a series of impulsive, selfish, inconsiderate, self-destructive and downright dangerous decisions that caused great harm to both myself and the people I cared about. I am still so deeply ashamed of the way I acted and the choices I made during this time that I can hardly talk about them with anyone. All the way, I was still seeing a talk therapist, and still taking ineffective SSRI after SSRI to no avail. Eventually I stopped going to therapy. I was still taking my pills, but I avoided actually seeing my psychiatrist as much as possible. I still didn’t see my unpredictable mood swings and bouts of rage as symptoms of what was going on with me. I felt like a completely different person, like I had lost who I was. I was worse than I had ever been before and I had no coping skills to deal with this novel state of misery.
I went back to college no more ready for it than I had been before, simply because I felt I couldn’t trust myself with my excess free time any longer. This was what I consider my true breaking point. It was like my first attempt all over again, but this time I couldn’t blame flu-like bodily symptoms for my lack of motivation and energy. My irritability and instability was out of control. I could go from crushingly despondent to blisteringly furious in an instant, with seemingly no trigger. My professors were kind and made every effort to aid me through my suffering, but I still just couldn’t get the work in. I took another leave of absence.
The good thing that came of this period, however, was that I finally began to talk to mental health providers about my extreme mood changes. I finally began to realize that my problem wasn’t just that I was melancholy all the time, but that I could rapidly cycle between fury and despair within a single day. I understood the definition of bipolar disorder as very strictly timed, predicable shifts from mania to depression. I thought mania meant euphoria, productivity, invincibility and nothing else. Finally, a psychiatrist told me differently. They said the definition of bipolar disorder was changing and expanding, and what I was experiencing fit much better into that category than that of mere depression. I was put on mood stabilizers and, in another first, felt like my medication was actually doing something for me. I started seeing a talk therapist again and later on joined a DBT therapy group, the combination of which allowed me to express my emotions while giving me practical skills with which to manage them. I got a job. I starting coping and began to hope. Now I’m back in school and I’m immensely proud of my performance.
But there is a catch. It is much harder telling people I have bipolar disorder than it was telling them I had anxiety and depression. It was difficult enough explaining that no, I can’t just “get over” my sadness, that no, I can’t just “relax” about the things I agonize over, that no, I’m not just lazy, or too high strung, etc. without having to explain that my disorder isn’t going to make me hurt anyone. Our society is just now beginning to understand the struggles that all of us with mental illness face, and is still inexcusably harsh on people for symptoms of which they have no control over. But certain illnesses invoke more fear and derision than others, namely those that are most associated with violence in our culture and media: bipolar disorder, personality disorders, and schizophrenia. Because of this, it’s more difficult for me to seek help from others and secure the accommodations that I need than it was before.
I’m far enough into my recovery that I feel as if I’m in a catch 22: when my symptoms are preventing me from accomplishing something I want or need to do, I either have to downplay what’s going on and risk people simply not believing me and thinking that I’m merely making excuses, or I can admit the extent of what’s going on and risk worrying or scaring them. I get unsolicited advice from classmates and other near-strangers about how I’m not ambitious enough or working hard enough in complete ignorance of how psychological disorders work, and I don’t know how to correct them without outing myself and therefore opening myself up to even more inappropriate commentary. I’m afraid of telling employers or potential employers that I might need special allowances because, even though those of us in the U.S. are technically protected under the Americans with Disabilities Act, they may find some other way to get around dealing with me that doesn’t appear outwardly discriminatory. While I am aware there will be always be good days and bad days for me, at this point essentially the stigma against speaking out about mental illness is causing me more harm than the mental illness itself is.
If you’ve made it this far into this rambling essay, thank you for hearing me out. Thank you for taking the time to listen to my story and validate my suffering and my triumph. If you’ve been through the same things I have, kudos to you. Your strength and perseverance is beyond impressive; to most of the world out there, it’s unimaginable. But what I really want is for all the people out there that are still mired in the thick of it, for those of you who are so tired of fighting that you are ready to give up, to take away from my experience that recovery is possible. Your expectations must be realistic: it will be slow and gradual, there will be highs and lows, setbacks and leaps forward, and there will always be people in your life who just don’t get it, but with the right assistance and support you can lead a wholly satisfying, fulfilling existence. The rest of us who have made it to that point will keep fighting for you, and for ourselves, to make our planet a better and easier place for all of us to succeed in.
Let others know that there is hope and understanding about mental health. Together, we can become stigma free. Take the pledge.