Since diagnosing myself with Bipolar one year ago (yes, I had to diagnose myself. keep reading) I have been frustrated, invalidated and continually disappointed by mental health professionals. And no, the tone of this letter is not angry because I'm in a "manic episode" it is the response any normal person would have to incompetency within a professional field.
Besides the amount of suffering and brain damage incurred in Depression and the destruction caused by impulsivity in Mania, Bipolar has a 1 in 4 successful suicide rate. As someone who has dealt with the extremes of the illness and experienced suicidal thoughts; and as someone who has read the stories of hundreds of other people with Bipolar through my YouTube, it is extremely disappointing how many people are slipping through the cracks and how attempts to help us often do the opposite. The dialogue seems to be that people with Bipolar are at fault for avoiding treatment and going off medicine. But all of the problems I’ve experienced have clear solutions and seem to instead result from a black-and-white and over-feminized view of mental illness that does not allow for an understanding of subtleties in how Bipolar manifests.
Up until the beginning of 2016 when I was finally put on mood stabilizers, I had been to a dozen different therapists and psychiatrists since late high school and none of them had mentioned I might be Bipolar. It is in my family history and that was always brought up at these appointments. I had been experiencing crazy sleep patterns, abnormal eating, vivid dreams, extreme empathy, times of intense crying, strange shifts between introversion and extraversion, spikes of creativity and an extreme over-involvement, etc. since high school and even middle school. Looking back, I can see that all throughout college, I’d been experiencing slight depression and hypomanic episodes, but none of that was noticed by mental health professionals.
Questions trying to track if my eating habits had changed always asked of a time I’d either lost or gained weight. Questions of sleep changes demanded a time when I’d lived for days on 3-hours of sleep for no particular reason. Empathy and vivid dreams were completely left out of the discussion. And everything else was attributed to personality traits. Entire depression episodes were overlooked because my depressions manifests not as a sadness or insecurity (the typical way females experience depression), but as a physical and mental fatigue and sometimes anger. What I’ve observed is that if symptoms do not perfectly fit into the DSM criteria i.e. are not full-blown, professionals act like nothing is wrong, nothing to medicate, end of discussion.
The only reason I was finally diagnosed and put on medicine is because of comments made by my ex-boyfriend who had discussed his observations of me with a therapist; and because of intense research I did months later based upon intuitions which led to me to an article on cyclothymic disorder. I had to make arguments to a psychiatrist I went to, essentially manipulate him to prescribe me lithium after he demanded that my hypomanic spikes do not signify Cyclothymic Disorder or Bipolar. I am an extremely assertive person and I found that fighting through the mental health industry, fighting with insurance companies, demanding and persuading that my intuitions and observations of myself signify Bipolar is the only reason I was able to get treatment when I did. I still wouldn’t be diagnosed if I hadn’t gone above and beyond to do my own research and to fight against what Professionals kept telling me. I saw slight mania in myself before it manifested into full-blown mania— something the professionals were not able to do—and getting on mood stabilizers before that happened was integral in protecting myself from even more damage.
I understand we shouldn't over-diagnose people. But I wish the emphasis were on treating the symptoms and protecting people’s brains over fitting specific criteria perfectly. Western culture, and thus Western medicine, is extremely black-and-white and I find that Bipolar has the tendency to be ambiguous and to develop gradually, but even those tinges of the disorder can be extremely destructive. Just giving a heads up to someone when they exhibit some symptoms that seem to be pre-Bipolar would be extremely helpful. Explaining to clients details of how Bipolar would look full-blown and educating them during a therapy or psychiatry session when they are exhibiting bizarre sleep patterns, extreme empathy, vivid dreams, etc. would allow the person to know how to get help when they later see it coming out.
I personally have moved around a lot throughout my life— especially with leaving for college— and many people also find themselves in situations where they’re not consistently going back to the same professional. The only constant is the patient and so to try to fill in the gaps rather than keeping all your thoughts to yourself. It would be helpful to educate us on mental illnesses that could later manifest. A huge part of Bipolar is this unawareness within the person who is Bipolar that their behavior is abnormal. We tend to experience emotions as more encompassing and intense than everyone else throughout our lives. Our minds may be racing, we may be talking fast, not sleeping or eating normally, obsessively working on a project; to us it feels normal. And partially because we have felt and lived within extremes our entire lives.
Expecting us to see depression or manic episodes in ourselves when we have not even been educated on what that is, is asking for us to not get treatment and to end up in dangerous situations. All that most of us know of Bipolar is a 15-minute lecture from our high school Psych class and stereotypes we here of being “so Bipolar.” That is not enough for us to notice when symptoms are manifesting. Explain to us what it is.
Mania can spike immediately. Major Depression can spiral down to disabling a person within weeks. Manic episodes can crash into suicidal thinking with no trigger. Bipolar can kill us and cause brain damage. It ruins relationships, causes us to get fired from our jobs, and to fail classes. It is so destructive to us and extremely dangerous. It needs to be treated with severity and we need to protect people in advance by communicating during therapy and psychiatry sessions when someone seems to be within a pre-Bipolar state of mind.
Here are 7 subtle indicators we might be Bipolar that are not in the DSM:
- Crazy sleep patterns all of growing up. Since elementary school, every time I’m sick my body will sleep for about 20 hours. This has always been seen as crazy and abnormal. Going into high school, I found that I could do fine on 3 or 4 hours of sleep. I became a pro at pulling all-nighters and then crashing on the weekends. A lot of times I was up late at night and would disturb my family. Sometimes I’d be eating in the middle of the night and be fine not eating all throughout the day— just these bizarre changes in energy levels. Jet lag would also be experienced very intense by my body. It would require so much sleeping to recover from. Since being a teenager and throughout college, often it was impossible for me to wake up to alarms, like my body needed 9-15 hours of sleep and even if I set 8 alarms, I would remember none of them.
- Intense writing and texting. Calling people in the middle of the night is outdated. But also not applicable to introverts. I would never randomly call someone without planning to, in any situation. And when I’m manic, I’m not necessarily more social. I just prefer being by myself almost all of the time. But calling is outdated! Instead ask about really long texts and messages or impulsive Facebook posts. I’ve sent angry emails or extremely long affirmation texts when I’ve been manic. I’ll type out straight-up essays in the notes section of the phone, perfect all the grammar and send them to my friends at 2AM. Everything will be effusive tones and the words will feel like they’re pouring out of me trance-like, but as a writer and an introvert, increased socializing will never mean calling someone in the middle of the night. Instead, mania manifests for me more in written form.
- Depression as something physical. I had a therapist once who tried to undiagnose my bipolar a year into being diagnosed, because I explained to her how my depression doesn’t feel like sadness. It was annoying and unprofessional. My brain in general tends to be more “masculine” in how I value logic over empathy in making decisions, am extremely assertive, etc. and I find that the mental health industry is over-feminized with therapy techniques and understandings of depression. Men tend to experience depression and mania more as anger, but also depression in bipolar just tends to be more physical symptoms— almost like a sickness— we’ll feel fatigue and our brains being slowed down. We’ll get headaches and sometimes feel dizzy or feverish and have tons of vivid dreams leading up to it. We’ll have the extreme changes in appetite and sleep, but sometimes none of the emotional affects of what people typically think of as “depressed.”
- Hypomania and depression could be entrenched in us going back years. We might have been talking fast for a while and just be faking a manic personality whenever we shift into a slight depression. This might be so intuitive, that we’re not even aware. We might not even know what it feels like to not be stressed and tense or to not be over involved, because it has become our normal. We might not understand the concept of "racing thoughts" because for years and years we've had consistent times of intense epiphanies and rushing creativity.
- Physical symptoms. In mania our body temperature and heart rate increases and our pupils become larger. All throughout high school, there would be times when I would suddenly feel so hot and uncomfortable. It was the same times when I would feel angry or be really stressed, i.e. a slight mania. And the times when I was in a slight depression, I would get compression headaches. I’m at a point now, where I can feel my mania based upon if my heart is sometimes racing and I can see how manic I am by just looking at my eyes. Even the types of dreams I have can show what episode I’m in, i.e. nightmares and bizarre dreams before mania and monotonous vivid dreams before depression. In fact, consistent vivid dreams are one of the biggest indicators for Bipolars of going into a depression episode. These physical symptoms have been for the most part completely ignored in therapy and psychiatry sessions, based upon my experience. I think they’re easy indicators in diagnosing and in helping us understand when we might be in an episode.
- General intensity. If we do things like listen to the same song on repeat for hours, journal 20 pages in one day, seem to be at high alert just a lot of energy in being our personality, these are all indicators that we might be Bipolar. Ask us what we do and what we are involved in and focus on how we talk, rather than what we’re talking about. Read our body language. Focus less on finding this extreme contrast between our “normal” and “mania.” Bipolar is engrained into our permanent brain chemistry, where we feel in these extremes our entire lives. If you see the beginnings of some other symptoms, the intensity and extreme empathy may indicate we are likely to develop Bipolar. And communicate that.
- Extreme empathy. Most of us experience that intensity in an emotional way, manifested as an abnormal amount of empathy. We feel other people’s emotions as if they are our own. We’ll react so strongly to natural disasters or shootings or extreme poverty. When someone we love is hurting, it feels like our own problem. And our empathy feels like emergency. We’ll care a lot about social justice issues and horrible tragedies going on in the world. We cry for other people and just feel everyone’s emotions in this encompassing way. We feel your emotions as our therapist or psychiatrist and we feel when you don’t understand and don’t have empathy for us.
If we have these symptoms, just tell us we might develop bipolar. You don’t have to over-medicate, just educate. Give us book suggestions or print outs with specific symptoms to look out for.
And when it comes to medicating, explains to us how it works and why we need it. Don’t just write a prescription or we’ll feel your callousness, not feel understood and not want to come back to treatment. Understand that some of us highly identify with our Bipolar attributes and are really scared to medicate away our personalities. Don’t ignore the identity question. Don’t assume we want to be medicated. Ask us how we feel about our diagnosis and how we feel about being medicated.
Understand that a huge part of being a successful Psychiatrist for someone with Bipolar is persuading us to comply with treatment, and do that gently and with compassion or we’ll resist. If you don’t explain to us in-depth what Bipolar is and how dangerous it is, but also how it has all these creative attributes, we might not believe that we’re actually Bipolar and we certainly won’t trust you to change our brain chemistry. If your attitude toward all types of Mania is that it is 100% bad, we will for sure go off medicine and not come back for treatment. Some of us enjoy some amount of hypomania for creative and productive purposes in a way that is actually really safe. If you don't understand that, you're just asking us to run away from treatment.
We need to be understood and we need to understand.
If you can't feel empathy or lack people skills, maybe this is the wrong career for you. Or maybe you just need to change, adapt, expand how you practice psychiatry and increase your emotional awareness. Learn how to emulate emotional validation and unconditional positive regard. We are suffering and often suffering much more than we show. It’s scary for us to talk about this and when we feel that our symptoms are invalidated again and again and not understood, we don’t want to come back and be vulnerable during an appointment.
We need to feel safe and we need to be understood. We need to feel like medicine is a team effort and that we are choosing our treatment plan, working together with you. We need to feel in control. It’s scary when part of who we identify as is defined as an illness and so if you try to just understand and empathize with our perspectives, we might actually enjoy coming back for treatment.