All Mixed Up

I haven’t written a column here in some time. I haven’t felt like I’ve had anything to say. I still feel that way. Like nothing I say is important or matters. Sounds like I’m depressed. Everybody around me says I’m stable. My psychiatrist, my counselor, my partner and my friends all think I’m fine. And I guess I am. Only in so many other ways I’m not. I was originally diagnosed with bipolar II, with mixed states and rapid cycling. I’m not sure if I fit the technical criteria for mixed states and rapid cycling or not. But it sure is my lived experience. And it happens all the time, every day. Or so it seems. In actual fact I’m sure it doesn’t, but I’m often in a mixed state, and the mood changes often happen more rapidly than I can easily handle. It feels like I’m bouncing around all the time.

I’ve been keeping a mood chart lately. I’ve also been charting my pain level next to it. The two so often go together for me. It’s been interesting, even though it’s only been a month. I’ve broken up the days into two or three or four hour sections. I put down a word to describe my mood and a number for my pain level. My pain has been pretty consistent at six or seven. With a few jumps up to eight or more. But my mood descriptors have been all over the place. Lots of Good’s and OK’s. But most of the entries seem to say Mixed or Depressed. When I fill in the space at the end of the day for overall mood and pain levels I have a lot of Seven’s and Mixed’s. What I want to focus on here are the Mixed days.

In bipolar disorder a mixed mood basically means you experience both the highs and the lows at the same time. That’s been a significant part of my experience for months and months now, maybe years. I’m not there all the time, by any means. But I’m there way too often for my comfort. I can be having a wonderful, cheerful conversation with my partner about how beautiful the garden is, while my internal dialogue tells me I don’t deserve to live in such a beautiful place or have such a lovely garden to tend. This constant back-and-forth makes me feel unsettled much of the time. Add to that the crippling social anxiety I experience as part of the PTSD, and the bipolar fueled rage that makes me feel like exploding half the time, and you can see why it doesn’t feel like I’m doing as well as I appear. And underlying it all is the constant low grade depression of the dysthymia. I may look fine but inside I too often feel like a basket case.

Fortunately my high times don’t ever approach major hypomania these days. But in my low times I go as deep as I’ve ever gone into the depths of depressive despair. In seconds my heart can plummet to the floor and my outlook becomes unbearably bleak. By then I can be in full suicidal ideation mode. Often there’s a trigger that sets me off, but just as often there isn’t one. To me it feels like it just happens in an instant, without any conscious thoughts on my part whatsoever. It’s very hard to pull myself out of that state. But I do it every time I have to, every day. Right now I wouldn’t even try to pretend I’m not depressed. I’ve been this way for a couple of days. But even now, if it was required, I could pull myself out of it and act normal, at least for a little bit. That’s why everyone thinks I’m fine. I maintain too well for my own good.

In reality it’s a lie I perpetuate out of shame, fear and embarrassment. At the moment I’m experiencing all of those emotions as I prepare to continue writing this piece. Because, as much as I’m embarrassed and ashamed to say it, I still don’t think I’ve come to terms with this fucking bipolar disorder. It will be 24 years next month since I was diagnosed. I thought I’d dealt with this and had come to terms with having this illness and accepted it years ago. Now it feels like I didn’t really get rid of the fear at all. In some ways the longer I’ve known I’ve had this disorder the more afraid of my perceived mental deterioration I’ve become. I say perceived because I know my brain itself is just fine. It’s my thinking that is disordered. I feel stupid. I know I’m not. But right now I feel ashamed of having bipolar disorder, especially the depression. And that’s just stupid.

As a gay man I know that coming out is a life-long process. The same is true if you have a mental illness. You may think you’ve come out but then you find yourself in another situation where you have to come out again. This has happened repeatedly for me as far as being gay. It’s not really an issue for me here in liberal Seattle, but when I go to conservative Eastern Washington it’s a very different story. It’s even more so for mental illness. Again, especially for depression. When I’m hypomanic everybody loves me because I’m charming, cheerful, charismatic, positive and full of life. When I’m depressed I’m afraid to even tell anyone because I feel so negative and boring. I’m sure no one really wants to even be around me. That often includes my partner Louie. I know he’ll love me forever regardless of my emotional state. But I’m still terrified that I’ll burn him out on me if I’m too depressed too much of the time. I know that’s crazy thinking, but it’s got me bad. So I hide my feelings, even from him.

If I feel afraid of burning out Louie, imagine how I feel about my neighbors and people in general. I’m bloody terrified. Most people still think depression is a failure of character or will power. Of course I know that’s nonsense. But it doesn’t stop me from buying into their opinions in some situations. When you’re already feeling vulnerable it seems crazy to make yourself even more vulnerable by acting depressed. People think you’re weak if you’re depressed and when you’re already vulnerable you can’t afford to look weak. This attitude seems to be shifting a bit in our culture now. But our cult of pull-yourself-up-by-the-bootstraps rugged individualism is still too strong to allow for those of us with depression. It takes a lot of guts to be who you are in this world. I say this as a privileged white boy. Imagine how much worse it is for a person of color, a woman, a trans person or anyone else who doesn’t fit society’s definitions of what it means to be a man, a woman or any other sexual identity. Or what it means to be mentally healthy and functional.

Everyone I know would tell you that I’m a high functioning individual who just happens to have bipolar disorder. That’s what they see and I have no desire to try to change those opinions. Except I sort of do. I want to feel free to exhibit my depression whenever I feel it so strongly. I want to be real and true and honest about who I am. But I’m scared. I’m afraid people will think less of me if they see me being depressed. I have what is often called a shame-based personality. That doesn’t mean I feel ashamed all the time, but when I do it can be overwhelming. I once told a counselor that I thought shame had stopped me from becoming manic at times. He laughed at me and told me mania was too strong to let shame stop it. I’m sure that’s true for full-blown mania. But shame has definitely kept me from acting out some of my worst hypomanic impulses. In some ways it has actually protected me from losing it. What a weird fucking paradox.

I rarely feel much strong hypomania these days. But even so when I’m feeling really really good I tend to ascribe it to hypomania rather than just a good mood. I don’t really act out the grandiosity but I certainly think of myself in that way at those times. A part of me still thinks I’m hot shit. It feels good to feel that way, which is why people like mania. Especially since I’m depressed so often. I can still go way overboard with the hypomania if it strikes me that way. My “episodes” rarely affect me for just the four day criteria needed for a diagnosis. They tend to be more diffuse and spread out over days, weeks, months and even years. A couple of years ago I spent about three months in a hypomanic state that I didn’t even know I was in until it was over. Balancing my checkbook was the clue that I’d really overdone it. I was chagrined and embarrassed that I had let myself get so carried away. Because underlying the hypomania was the usual depression, and I really didn’t feel that good about myself. I was in a mixed state.

I hope I’ve given you some idea of what it’s like to live with mixed states. As I’ve said, it can be a real challenge. In my high times I tend to do things and make promises that when I’m depressed just fall apart. I’ve always tried to be a very responsible person and to walk my talk. I think I’ve mostly been pretty good at that. But as I look back over my life I see so many times that I blew it. In fairness to myself I also see plenty of times that I did OK. Most of my life I’ve lived in a hypomanic haze, with periods of depression now and then. I’ve been able to function really well and I’ve created some good things in my time. But the last 24 years have been really hard. I haven’t been able to hold a real job in that time, even though I’ve done some good work now and then. This really affects my self image. I feel like a failure even though I know I’m not. Feeling good, feeling bad, feeling good, feeling bad – it’s a constant merry-go-round of emotion, especially when both things are happening at the same time.

My hope is that I will continue to learn that when I’m in a mixed state I need to moderate my behavior as much as I do as when I’m depressed or manic. Sometimes I think I’m doing really good at that. I’m depressed right now so everything looks pretty bleak. But if I know anything about depression, I know that it doesn’t last forever. One of these days I’ll start feeling better again, maybe even today. Mixed states give me a different perspective on reality than most people get to have. Just having bipolar does that. So I could view all this as a good thing. I’m trying hard to do that. Sometimes I’m even successful. I hate to be trite, but yes, there often is a silver lining. It’s pretty dim right now but with any luck it will get brighter in the near future. I won’t say I have much hope, but I do know that the wheel of life keeps turning, and sooner or later it’s bound to come up roses.

With mixed emotions,

Steve

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A Chronically Discontent Manic Depressive

I was diagnosed with Bipolar Disorder in late 1994 and I’ve had 22 some years to study and learn about this illness. I’ve learned a lot. I read books and magazines all the time and I search the internet. I’ve learned how to dance with this disorder pretty well, especially since last year when I was put on a new mix of medications. I’m doing much better. In fact I feel pretty stable for the first time since my diagnosis. It’s still hard, but at least I have a clue as to what’s possibly coming down the line towards me. My brain is different than it used to be and it’s taken some getting used to, but I’m getting there.

Last year I was also given the diagnoses of PTSD and Dysthymia. I’ve been studying about how these disorders affect me since then, and again I’ve learned a lot. But it’s still new, and I don’t know as much as I need to. I recently read a book called “The Half Empty Heart”, by Alan Downs, PhD. It’s all about Dysthymia, or what he calls Chronic Discontent, and man I can relate all too well to this description. It’s also called low grade depression because it’s always there and never really goes away. You’re in a low state of depression basically all the time. It cycles some but mostly it’s just there, underlying all your actions and thoughts. I read this book a few years ago and it intrigued me, but I didn’t have the diagnosis yet so I just thought about the subject and how it affected me. But since I’ve been diagnosed with it and know more I can see that it’s affected me my whole life. I’ve learned a lot more reading it this time.

One of the main things that people with Chronic discontent deal with is a tendency to emotionally and physically withdraw from stressful or difficult situations. It’s a hallmark of the syndrome in fact. And it’s one of the hardest symptoms to handle. There are exercises in the book that are intended to help you overcome this, but I haven’t gotten too far in that. But I have read enough to know that withdrawal has been a constant theme in my life, since I was a young child in fact, right up to today. When things get too hard for me, instead of trying to work it out I often tend to just disappear and run away from the hard stuff. I can’t tell you how many people and situations I’ve abandoned in my life. Dozens at the least. I’m not happy about this, in fact I’m totally ashamed of myself. That’s a big part of the symptomology too. Experiencing shame is the way we live our lives, based on perspectives we developed when we were very young. We just don’t feel like we’re OK as human beings deep inside of ourselves.

A shame based life is filled with regret and unfulfilled promise. We respond to life as tho we feel we aren’t as good as the people we interact with, and so we self-sabotage many of our relationships. We often are left with no one to call friends any more. That’s my situation. I’ve left so many people that there are just a few left. As I get older this is a big problem. And I don’t have a clue how to overcome it. It’s buried so deep in my pysche and I’m so terrified of changing it that it informs most of my decisions. It might as well be who I am. But it’s not. I still refuse to be defined by my diagnoses, but it’s hard not to be. I’ve always been ashamed of who I am, despite all the good things I’ve done in my life. It’s like they don’t matter and all I can see are my failures and abandonments. This has been true for as long as I can remember, even as a small child. In fact that’s where it started I’m sure.

I don’t mean to blame anyone for this, but it seems clear to me that this began in my childhood, and of course that means that my parents were at the root of the situation. I had wonderful parents and they loved me so much. They were happy to have me, but I was so sickly that they severely overprotected me and I grew up believing that I was too much an invalid to do too many things. This despite the fact that they also told me I could succeed at anything I tried, and I so often did. But the shame I developed over that time lives on today. Back then it was an undefined feeling that I was inferior to other people. I still feel that way. I know that both my parents suffered from low self esteem and I’m sure that it translated into my psyche at a young age. How could it not? Again I don’t blame them. They were just living their lives the best they could after all. But I never talked to them about this before they both died. Now I can’t ever deal with it with them and it’s up to me to overcome it alone. It hurts my heart because I love them so much and yet they left me with such a painful legacy.

The title of this book – the Half Empty Heart – is very powerful to me. It’s a hard thing to face but it’s the way it seems to be. We tend to look at life as a glass half empty instead of half full. And in that we fail to take care of our hearts. It’s very painful when the reckoning comes around and you see all that you’ve lost thru your lack of action, or actions you’ve taken to escape. It seems like every time I begin to have a good life and accomplish something, I sabotage it somehow and end up with nothing left. This is a common experience for people with chronic discontent. We stop ourselves before we’ve even given ourselves a chance to succeed. I’ve so often declined to even begin something because I was sure it was doomed to failure. It’s not that I lack courage. I just don’t have the faith in myself.

But here’s where the mix of diagnoses comes into play. Having Bipolar disorder means that you may cycle constantly and can be up or down depending on your current mood. When you’re “Up” you feel on top of the world and I think that because I’ve lived so much of my life in hypo/mania – the good stuff feelings – that it overcame a lot of my chronic discontent and allowed me to do more than I might have otherwise done. I couldn’t help but feel good about myself, even if it was based in mania and not reality, it still felt good and I believed it was real, so it was. In a strange way I feel lucky to have both of these illnesses together. I think that life would have been much worse for me if I’d just been chronically discontent, or just manic. I probably wouldn’t be here by now I suspect. I think that having those up times of bipolar mania allowed me to distance myself from the bad feelings and I had the courage to do all kinds of outrageous things that nurtured me and kept me happy despite the low grade depression I still felt deep inside. It was a strange mix, and it still is.

The other side of it is that the dysthymia often kept me from displaying florid manias to other people because I was too ashamed to “act out” and embarrass myself. I so often hid my horrible feelings of distress deep inside so that no one could tell that I was experiencing such difficult emotions. In some way I feel that this saved me a lot of heart ache because I never got “caught out” with my Bipolar until I was old enough to make better sense of it than I would have in my younger days. If I’d been diagnosed with it in my teens, as most people with BP are, I would never have accomplished half of what I did do. So the two diagnoses have worked in tandem to help form my life as it is now. Not great perhaps, but I’m not in a hospital (tho I have been) and I’m not dead (tho I’ve tried to be). But I haven’t been that successful in my life either. Depends on how you gauge it. I’ve done good things but I never made much money, and that’s how we judge success in our culture. So I feel like a failure even while I revel in my good works. It’s a weird way to live I guess but it’s what I know and have done. And I suspect there are others who have similar experiences.

I hope I don’t seem to be complaining about any of this. I assure you I’m not. I get it that I’m the one responsible for my actions and ways of being in the world. I’m not making excuses. I’m the one who bailed on my friends and communities in my chronic discontent, and I’m the one who was manic and did great things while I was too. I find it fascinating to try to embrace these two different illnesses. And I haven’t even touched on the PTSD. I could write a whole post just on that. All these diagnoses work together for me, sometimes in helpful ways, as I’ve described, sometimes in terrible ways too. I’m still working on the challenges of having these disorders and sometimes I think I’m even making progress. I hope I am anyway. Life is too hard for me too often, but it’s also so beautiful. I’m a lucky guy actually. I have a wonderful man who loves me to death and I have a home and good food to eat, and so much more. I even have good health, despite these disorders. So take all this as a discussion of how one can manage to live with these challenges and how I personally have dealt with them. At least it makes some sense to me…

If any of this resonates for you too – there is help. Go find it!

Steve