As promised, here is my essay on my experiences with bipolar disorder.

Sun, 12 Oct 2008 22:09:54 GMT

Just as a warning: this essay assumes that you know some basic facts about bipolar disorder already. (It was written for the students in my Abnormal Psychology course, who, presumably, have been reading the textbook.) If you don't know anything at all about bipolar disorder, just click here and start reading.

I glanced at the door. Maybe if I just ran out, it would all go away; maybe if I ran out, I wouldn’t feel as though I were about to explode from the sheer energy pulsing through me. I glanced around at my classmates. Everything was too loud, too bright. For the past few weeks, I’d dealt with my excess energy by multitasking and attempting to answer every question the teacher asked. But that wasn’t enough. I glanced at the door again, and then at the clock. There were fifteen minutes left in class. Could I stand to sit still for fifteen more minutes? I didn’t know. I didn’t know what was happening to me, either. All I knew was that I couldn’t do this anymore.

I know now that I was having my first manic episode. In retrospect, it seems painfully obvious. I’d impulsively signed up to go to Ecuador for five weeks in the summer preceding that school year; while I was there, I rarely slept more than three hours. When I came home, I decided to take eight classes, five of which were Advanced Placement. For a while, it was amazing. I didn’t need to sleep. I didn’t need to eat. My work got done in a flurry of activity, and even my cross-country workouts didn’t tire me. My friends remarked on how constantly “up” I seemed.

That, alas, didn’t last. The day after I nearly broke down in class, I went up to my parents and, crying, begged them to let me stay home. They agreed; I later learned that they’d realized that my behavior was unusual way before I had. (This is not an uncommon phenomenon; relatives and close friends usually notice manic symptoms before the person suffering from them does.) At any rate, my parents took me to see a psychiatrist at the end of the week. When I walked in, my heart was racing; I had so very, very much to say. I talked non-stop through the whole session. When we were done, the doctor told me to wait outside so that he could speak privately with my parents. It was then, at sixteen years of age, that I first received the diagnosis of bipolar disorder.

The second half of my senior year was as hellish as the first half had been wonderful. I essentially stopped going to school; I simply couldn’t. I experienced something known as “ultra-rapid cycling,” which is common in early onset bipolar patients. In other words, my moods would change from euphoria to crushing depression within days, if not hours. I was put on various different medications. Some had little effect; one, in fact, even made me worse. But after a while my doctor found a cocktail that mellowed out my mood swings. I no longer spent hours jumping up and down to burn off manic energy, destroyed my possessions while in manic rages, or spent entire days sitting on my bed crying. I just had to face the reality that I had been diagnosed with a severe mental illness with which I would have to deal for the rest of my life.

So I did what any sixteen year old faced with this would do: I went into denial. I refused to believe that I was bipolar. The doctor was wrong. I was “just making it up” for attention, or to get out of school. Believing this always made me feel like a horrible person, but feeling that way was preferable to accepting the fact that this was something that I could not control. I went off of my medication several times; this inevitably resulted in relapses back into more extreme moods. Even in the face of this overwhelming proof, however, I refused to believe in what my parents and my doctor were telling me.

It was for this reason that upon entering college at Columbia, the first thing I did was toss all my medications into the trash. I wasn’t bipolar; if I stopped taking these things, everything would go back to the way it was before. My semester was tumultuous, to say the least; by the end of it, I looked around my room, which I had trashed while in manic rages, and down at my arm, which was covered in scars from injuries I’d inflicted upon myself with razor blades, and decided that maybe there was something to that bipolar disorder diagnosis after all. I told my parents, and decided to go back into treatment.

I wish that I could leave the story at that. I decided to go back into treatment, got better, and none of this ever happened again. But that’s not what it’s like to live with a severe mental illness. Even when you do your best to control it, it never goes away completely, and new stressors can trigger full-fledged episodes even when you are on medication. This is what happened last year, which – had I stayed in school – would have been my senior year. I believe that this episode was triggered by two main factors, one of which was psychological, and the other of which was psychopharmacological. I had just entered my first serious romantic relationship, which was tremendously exciting; in terms of medication, my doctor had just ever so slightly raised my dose of my SSRI antidepressant. In conjunction, these two factors led to the worst manic episode I have ever had.

I was hospitalized for the first time in September, shortly after withdrawing from school. Upon returning home, I got a job at a local Borders. My medications still weren’t right, though, and my mania resurfaced. I started refusing to take my medication; before long, my behaviors were completely out of control. I spent five thousand dollars – all of my savings – in one month by buying absurd things on Amazon.com. I was cutting myself more frequently than ever to control the angry energy inside me. After my father had to physically restrain me from so doing, I attacked him. This led to my second hospitalization. Each time, I stayed for about two weeks. On my second hospitalization, they found a drug that truly worked for controlling my mania: Zyprexa, an atypical antipsychotic. (Atypical antipsychotics, in conjunction with mood stabilizers, are now often used to treat Bipolar I Disorder.) After I calmed down, I was discharged from the hospital.

Almost immediately thereafter, I feel into a deep depression. The “ultra-rapid cycling” that had characterized my mood swings when I was first diagnosed was gone; instead, I had just gone through months of mania and was headed for months of depression. I couldn’t do anything; I was frozen, paralyzed. I had to quit my job. My doctor carefully added in another antidepressant. After a while, it began to work. I felt better. With the help of my therapist, I began to feel ready to return to Columbia.

Before I did in fact return, however, there was one more bump in the road. Zyprexa, which is notorious for its side effects, had caused me to gain forty pounds in four months. I was also constantly sleepy. Consequently, I asked my doctor whether I could switch to something else. He prescribed me Abilify, another atypical antipsychotic. Two weeks later, I was in the hospital again. I remember exactly when I got admitted that time: it was the fourth of July. There, they immediately put me back on Zyprexa; by the time I left, I was on a combination of Zyprexa and Abilify, along with two other medications.

Now I’m back at Columbia. I am on six different medications, two of which counteract side effects from the other four. I struggle to stay stable every day. The slightest things can trigger episodes; I have to be sure to sleep enough, to take my medications at the right time and to use coping strategies I’ve learned in therapy when my moods do overpower me. I am constantly on the watch for signals that I am spiraling into another major episode.

It will soon be exactly one year since my second hospitalization. During it, I was on a locked ward. When I became out of control, they would isolate me in a “quiet room;” I would then have to spend the next day on “constant observation,” with a nurse following me around wherever I went. I am a person with Bipolar I Disorder. But I am also a student, just like you. Maybe you’ll look around the room, wondering who wrote this. You won’t be able to tell. But I hope you’ll now know more about bipolar disorder and what it’s like to live with it. If you want to learn even more, I highly recommend Kay Jamison’s book An Unquiet Mind; in my opinion, it’s the best bipolar disorder memoir out there.

Thanks for reading, guys.

I would very much like to know who read through it; if you do, leave me a comment. It doesn't have to be detailed feedback; a simple "I read it" will suffice. Of course, if you want to write more than that, I would be thrilled.

Susanna's Journal

As promised, here is my essay on my experiences with bipolar disorder.