October 16, 2013

AliceIt is common for people with bipolar disorder to question where the separation is between themselves and the illness – where does one end and the other begin? The answer is largely elusive.

Many of my flaws, or negative personality traits, are just a part of me. But I am neither the anxious depressive who cringes away from social interaction, nor the supremely confident manic egoist. I am somewhere in between what often feels like two separate people. The irony is that I have been relatively stable lately but perhaps if I had more severe episodes more frequently it would be easier for others to see what is the illness and what is me.

The stigma of mental illness is well-documented

The stigma of mental illness is well-documented. It can cause a great deal of guilt and shame in sufferers. I’m fairly open about my bipolar, the title doesn’t bother me as much as it used to, but there’s a deeper type of shame I find myself wrestling with. This shame concerns the unwitting audiences to my episodes, comprised of pretty much anyone who witnesses me in these states.

My depressions can be easy to hide from people, I’ve become quite good at wearing a mask that largely conceals them. But my manic phases are far more visible and public and have had some devastating consequences for my personal relationships. The impact has ranged from misunderstandings to wrecked friendships, all of which cause me deep shame.

These people have understood much and forgiven me much

When depressed I am locked away in my own misery unable to communicate with the rest of the world. The depression tells me that I truly am a horrible person and that I use being bipolar as an excuse for this. On the whole I experience this behind closed doors.

But when manic I lose the ability to observe or analyse my own behaviour, I have no understanding of my own behaviour and do not comprehend the risks I take. This makes it far more visible to others, so much so they may only think they witness me manic, seldom depressed. Mania alters your personality, like a drug, it can make you over confident, aggressive even, promiscuous, reckless and very self centred.

Some friends and family have still been able to see the ‘real me’ through the ugliness of mania and the desperation of depression, and have realised that I substantially lacked control of my thoughts and behaviours at these times, and indeed was not really ‘myself’ at all. These people have understood much and forgiven me much, and I am eternally grateful for their perception and compassion.

Mental illness and a broken brain are largely invisible

Others have taken my behaviour at face value, perhaps because mental illness and a broken brain are largely invisible, perhaps because they have limited understanding of mental illness. They have concluded that I am a selfish arrogant person (when manic) and have either removed me from their lives or hold me at arm’s length. When I am depressed they perceive me as flaky and unreliable for bailing on social commitments. These reactions cause me pain and shame in equal measures. They suggest that understanding of mental health problems, whilst making remarkable progress, still has a long way to go.

Sometimes, a friend will joke ‘do you remember that time you .....’ and relate some mildly amusing manic anecdote I had happily forgotten about. This is just mildly embarrassing. Other instances are more damaging.

The example of others lack of understanding that really sticks with me was when my twin sister died a few years ago. This coincided with, and largely precipitated, a manic episode, which I deeply regret as I was unable to offer my parents the support I might have been able to if well – instead I added to the things they had to deal with. The funeral was a blur and I remember little, although people tell me that my speech was ok and not inappropriate. Before the service, I recall being quite preoccupied with my outfit, a manic fixation that must have seemed grotesquely out of place to those around me.

She did not understand that I was extremely unwell

This was when a well-meaning family friend took me aside to tell me that the day ‘was not all about me’. Taking my behaviour at face value I can hardly blame her, my focus was appallingly wrong. But despite having known me all my life she did not or perhaps could not understand that I was extremely unwell, mentally.

People deal with grief strangely even without being in the midst of an episode of mental illness and my sister’s death had not fully hit me. I can’t recall what my response was to her, if I responded at all. The conversation didn’t shame me until much later when I had crashed back down from my manic episode. Looking back I am devastated that she felt she had to say that to me. It has scarred me emotionally, so much so that I wonder if it would have been better for all concerned if I had not attended the funeral but had instead been hospitalised. I am left with the sneaking suspicion that she (and many others who have seen me when unwell) think that I genuinely am that horrible self-centred person. The thought haunts me when depressed, effectively crippling me and I struggle to move past it.

It isn't always easy for people to tell the difference

With medication compliance and the support of those around me I see my true self emerge and the worst bipolar qualities recede, but it isn’t always easy for other people to tell the difference. What I see as the nicer bipolar qualities, such as intelligence, wit, creativity, and above all the ability to empathise, I’d like to hang on to these associations if that’s ok.

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