On being bipolar

Published in the Mail & Guardian, 28 July 2005, under the somewhat misleading title ‘Mindful of Mania’

To have the levels of carbamazepine in my body tested, I caught the train from Muizenberg to Fish Hoek at 5pm today, and walked a kilometre to have blood taken. It’s not a walk that would usually tire me, but today it’s exhausting. The lab office should be open till 5.30pm, but it’s closed and dark. I experience a surge of rage, imagine smashing the darkened windows. It would be a relief to give in to my ungovernable emotions, to finally ‘prove’ that my appearance of coping is practised acting.

Dragging myself back to where I am house-sitting in Muizenberg (having no home of my own), I feel consumed with self-loathing and despair so intense I want to crawl out of my own skin. Were it not now so familiar (hence better understood and resisted), the urge to suicide might be overwhelming.

I am bipolar. ‘Manic depressive’ is the phrase the world is more familiar with. Carbamazepine is a ‘mood stabiliser’.

In the last six months, I have been almost entirely unable to work, have lost a treasured relationship, a home, several work opportunities, my self-esteem, 99% of my usually abundant supply of hope and optimism, and thousands of rand spent on so far useless pharmaceuticals and a psychiatrist of intermittent competence. I have been forced to ask my parents to bail me out of debt. I am months overdue in completing a sizeable report for an HIV NGO.

If you think bipolar disorder is a mental disorder, think again. Actually, please re-think your entire categories for ‘mental’ and ‘physical’ illness. It’s past time we abandoned our simultaneous notions that overtly physical illnesses are unrelated to the workings of the mind, while illnesses like depression are unrelated to the malfunctions of the body.

These contradictory notions are expressed in conventional medicine’s treatment of so many ills as purely physical and in the abiding popular notion that succumbing to depression is malingering. In fact, bipolar depression is a physical illness, which happens to have predominantly mental symptoms. You can’t ‘snap out of it’, no more than you can snap out of having a broken leg.

How do I know that depression is a physical illness? Well, the painful sensitivity, poor concentration, suicidal thoughts and emotional abyss of depression comes with these physical symptoms: fatigue, disrupted sleep, reduced stamina, unpredictable and random bodily pains, and a greatly diminished sex drive. It can be treated most directly, physically, by the skilled use of mood stabilizers and anti-depressants, electro-convulsive therapy (‘shock treatment’) and some new forms of direct magnetic stimulation of the brain.

ECT is drastic, but highly effective in most cases. The fifteen treatments I underwent in 1996 propelled me within a couple of months from hospitalised basket case to high-earning freelance copywriter. They also destroyed my memory of much of that year, and of places and routes I’d known since being a child. Sometimes I dream that I am having a seizure and am wrenched awake by a blinding light sensation in my head. My feelings towards ECT range from dread to yearning.

One of the most striking, recently discovered physical symptoms of severe depression is atrophy or shrivelling of that part of the brain called the hippocampus.

Anti-depressants? Well, I’ve spent over R16 000 on them in the last year, and have seen little effect. That does not mean they don’t work; but finding an effective combination can be long and tortuous process.

New drugs are discovered only accidentally and released onto the market after minimal studies. Pharmaceutical company-funded studies alone cannot be trusted: a former editor of the British Medical Journal has recently concluded that the drug peddlers have become adept at manipulating both studies and so-called independent journals (New Scientist, 21 May).

If at this point you feel somewhat ignorant about bipolar disorder, rest assured you are least in company with a vast portion of the medical profession. Just a few days ago, I heard a reliable report of a doctor who declined to prescribe anti-depressants for a distressed UCT student on the grounds she is too young to be thus ‘indulged’. The student in question has since gone missing. The doctor, no doubt, is comfortable in his ignorance.

It is in part my proximity to the world of HIV, that parallel universe which our country so comfortably neglects behind a fog of ‘awareness’ that has inspired me to write this, for HIV has led me to think a great deal about the disclosure of chronic, stigmatised illness.

It is the hiding of HIV that makes it so unmanageable. If our government had the vision and courage to test and counsel and provide condoms to the entire population, the epidemic could be stalled within months. But so long as the bulk of the huge HIV positive population cowers behind ignorance, secrecy and fear, such obvious but expensive actions can be indefinitely postponed by our elites (white and black, business and government).

It would be hypocritical, though, for me to continuing advocating openness about HIV, as I routinely do in the course of my work, but to conceal my own stigmatised illness. Writing it is cathartic; hopefully it will help others.

Actually, bipolar depression and HIV have some things in common. Both can be deadly: a terrifyingly large proportion of bipolar disordered persons commit suicide, sometimes even after years of successful treatment.

Both HIV and bipolar depression require commitment to life-long, costly medication. Both are most successfully managed when one adopts a thoroughly healthy life-style: minimal alcohol, good diet, regular exercise and skilled management of stress. Both can put a damper on one’s sex life, both remain the targets of much stigma and ignorance … this is as much of an equation as I am qualified to draw.

Fear and incomprehension of bipolar disorder abounds, even amongst the ‘educated and enlightened’.

The more notorious form of bipolar depression is called bipolar I (incidence: 1% of the population), where acute depression alternates with acute highs of sleeplessness, euphoria, rushing thoughts and much diminished responsibility. I seem to be the more common bipolar II (3-4% of the population): my mania is infrequent and mild.

Contrary to popular belief, depression is not the unstable fuel behind the soaring creativity of many a tortured prominent soul (van Gogh, Plath, Churchill etc). Talent and depression may often co-exist, but bipolar depression, as with most forms of unhappiness, only stifles and frustrates thought and productivity.

That does not mean depression does not come with certain potential gifts. In my case, it has awakened compassion and understanding for the sufferings of others. Indeed, feeling one’s life is in the grip of irresistible internal forces has awakened unsought but undeniable empathy with serial killers, paedophiles and other less notorious classes of criminal. (Those who resist thinking that some forms of criminality might be strongly related to mental-physical illness should consider a recent study in a British prison which showed that merely feeding especially violent prisoners a healthier, better balanced diet reduced violent incidents by 40%.)

Beside deepening my sympathy for others, my depression has spurred my practice of an accessible form of Buddhism, which has helped overcome disempowering modes of thought, and helps cultivate those parts of myself deserving cultivation. Buddhism may not actually diminish depression, but my depression has become smaller in relation to those parts of myself I like. Despite all the pain, I doubt I would exchange what depression has helped me learn for an easier life.

Two weeks after first writing this, I have had an extraordinary experience. My depression has finally begun to lift, I think. For the first time in many months, I find myself making up nonsensical ditties and singing them on the way to work. Never before has the lifting felt so tangible.

Yes, for the past three weeks, I’ve been in a new job (one that came to me, thank heavens), and superficially functional. But it has been very hard. What changed things is simply an increased dose of carbamazepine. It has lifted the formless guilt and the grinding effort of motion. The inner vacuum has eased.

Without a chemical additive, everything might again grind to a shuddering, traumatic, halt. But now that the switches have been thrown in my brain, the creaking machinery of that organ has a chance to re-awaken.

Some may think I am ill-equipped to argue we may have it in us to overcome even great frailties of mind-body, when such frailties still so clearly dominate my own life. I can only answer that so long as I am alive, and reasonably at peace with my own humanity, the argument remains mine to win, at least for myself.

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David

I am an environmental writer, journalist and speaker living in Cape Town, South Africa.

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