(The author of this post is choosing to remain anonymous for privacy reasons).
Last week, the NYT ran an article entitled “The Problem With How We Treat Bipolar Disorder.” As a person diagnosed with Bipolar 2, I was eager to read it. While I am out to my friends and loved ones about my condition in the hope of gradually de-stigmatizing mental illness, it’s still not something I feel safe talking about freely. And yet, I am starved for more information. There is a dearth of open and honest dialogue about Bipolar disorders that aren’t sensationalistic depictions that fuel the stigma. I still don’t know what the hell causes it, and my shrink doesn’t seem to either. I don’t even know if it’s the correct diagnosis, or just as close as my psychiatrist could get with my cluster of symptoms.
I know a lot of other women with my diagnosis, and we’re all eerily similar in a way- highly intelligent, super creative, femme fatale types that walk a fine line between madness and exuberant intensity. We live closer to the edge and we are less held back by conventional fears, we are less afraid to be honest and open, which means we get to have incredible experiences that other people may only dream of, but it can also land us in the hospital, debt or jail if we’re not careful. I think that there is a lot of creative, charismatic brilliance that goes along with Bipolar, and I’m not even entirely convinced that my hypomanic episodes are entirely a bad thing. They feel like the only times in my life where I’m really being as productive as society thinks I should be.
The darkside, however, is my fear of having my life fall apart if my already strained functionality is compromised- and sometimes it doesn’t take much. I’m on a mood stabilizer that works decently well: unlike the author of the NYT piece, I’ve never struggled with losing my sense of self after starting medication. I still feel like me, but a more “manageable” version of me that can respond to life’s challenges, instead of blindly reacting. My awesome medication Lamotrigine was not approved for my Bipolar II until 2006 (I started taking it in 2010). Linda Logan, the author of the NYT piece, was diagnosed in 1989, long before Lamotrigine was available, and her medication options may have been less than ideal compared to mine (a shrink offered me Lithium in 1999, I flatly refused and never looked back). But nevertheless- she had the resources to try a gamut of medications under the supervision of a competent shrink. Even if the medications didn’t work, she had the option to try. Many people diagnosed with bipolar disorder don’t have that option. About 50% of people with bipolar in the U.S. are untreated, the numbers are much worse in poorer nations. Some of them may never receive the correct diagnosis or any care whatsoever.
In the 6 page essay, Logan describes her descent from PhD student and happily married mother of three to no less than five serious hospitalizations (I think? I lost count, honestly). Her main complaint within the piece is that the medication and treatment strategies caused her to “lose her sense of self.” Her symptoms were admittedly much worse than mine have ever been (I have never suffered serious suicidal ideation or the type of psychotic break she describes at one point). I do not by any means wish to minimize her experiences and suffering, because her experiences are genuine and valid, and there are already too many people who are dismissive of the suffering of mentally ill people. But to be perfectly honest, I didn’t find the piece relatable, or at all comforting. I guiltily found myself resenting that her major complaint was “losing her sense of self” through medication and hospitalization, because FUCK, at least her insurance presumably covered those hospitalizations, and she didn’t find herself contemplating bankruptcy on top of her mental health crises.
Her essay is a perfect illustration of one of the biggest problems with the U.S. health care system- the paradox of excess and deprivation. Maybe trying fifty different medications is how doctors know how to treat insured middle class white women struggling with mental illness, but maybe it wasn’t what Logan actually needed? Meanwhile many of us don’t have access to even the most basic care. We’re constantly told to “seek help” by well-meaning neurotypicals when our problems become more than they can handle as a teacher, friend, spouse or boss, but it’s a hollow platitude. What the hell does “help” mean when almost 50 million Americans are uninsured and the public health system is underfunded and inadequately staffed? What are you supposed to do when you’re thinking about killing yourself RIGHT NOW and the soonest a psychiatrist can meet you is 3 weeks from today?
I am a highly functioning individual with bipolar 2. I work, go to school, maintain my relationships and my household with some help from my medication, therapy and an excellent social support system of friends, family, and partner. I am lucky enough to have insurance that covers my pills right now, although I pay for my psychiatrist and therapist out of pocket thanks to my “pre-existing condition.” I work a contract job that will expire in a little over a year, taking my minimal insurance coverage with it. I lie awake at night wondering if I’ll be able to find a job that will enable me to survive once this relatively undemanding one is gone. (I lost three jobs in a row in my mid twenties and went into significant debt in due to my inability to hack certain types of high-pressure work environments).
I am functional on the surface although I am sure I am perceived as “eccentric,” “selfish,” “bitchy” or “high maintenance” by neurotypicals who aren’t aware of the tremendous emotional labor I perform on a daily basis to appear somewhat “normal.” I beat myself up over it, I feel like I’m lazy and malingering and not good enough compared to everyone else. I lose whole days to migraines and sometimes can’t fall asleep until it’s time to wake up, but I still have to get up and start my day. I’ve had days when I’ve gone into work when I have bronchitis because I already used up my sick days as mental health days (usually disguised as a headache or food poisoning because it’s not okay to call in “bipolar”). It’s damn hard work living in the mental illness closet and pretending to be okay when I’m not, but the alternative- going on disability (if I could even qualify) and living in poverty- sounds so much worse. I know I am intelligent and skilled and capable. I want to work and be a productive member of society, but society often demands a lot more than many mentally ill people (and neurotypical people, too) can handle to earn enough money to live, and to get the insurance we so desperately need to be functional.
While losing one’s sense of self is a big deal, it seems like a sort of like a first world problem compared to the issues faced by people who don’t have insurance or enough money to cover treatment, aren’t functional enough to hold down a full-time job or navigate the system to go on disability. I can’t afford to fall apart the way the author describes-perhaps my fear of homelessness and poverty is what keeps me baseline functional. The author says she’s better than she used to be, but not 100%:
…Although I don’t have to battle to stay awake during the day, I still don’t have full days — I’m only functional mornings to midafternoons. I haven’t been able to return to teaching. How many employers would welcome a request for a cot, a soft pillow and half the day off?
I have identical limitations in my functionality, but unlike the author, I don’t have the luxury of not working. (It’s not entirely clear how she can afford to stay at home as a full-time bipolar person- it’s not addressed in the piece). The last time I worked full time in an office, I made up for this lack of late-afternoon functionality with a prescription for a low-dose of ADHD drugs that essentially forced me to be functional through the magic of amphetamines. It was better than losing another job. I am sure that many shrinks would frown at this off-label treatment plan, but could they really be able to offer me a saner alternative? My doctor is both compassionate and pragmatic enough to understand that I needed that extra help to hack it in a system that often works against me. I needed that additional medication to be functional enough to work full time to get the insurance I needed to get the medication I needed to be be functional enough to work. Taking Adderall is not ideal, but it beats moving back in with my parents because I can’t “make it” as an independent adult.
I was not surprised to see that the comments section of Logan’s articles was filled with responses from countless others who felt the way I did- that while Logan is brave to share her story with the world, that the article did very little to address many of the serious problems faced by many of people who struggle with the disorder. The problem with Bipolar (and other chronic, potentially disabling illnesses) is that most of us have to chose between a limited number of bad options, none of which help us function well in society. Logan has clearly suffered a great deal, but she also had options that most of us don’t. It may be hard to be self-aware of your privilege when your life is torn apart by illness, but those privileges can literally mean the difference between life and death. It wouldn’t be fair to say that Logan is low-functioning because she has the luxury of being low functioning. But fuck, I REALLY wish I had that luxury sometimes.
So what about the rest of us? I guess the Bipolar 99% are too damn busy trying to hold it together to write our stories for the New York Times. We’re probably not their target audience anyway.