In Defense of My Worst Enemy

“While bipolar often feels like my adversary, I’ve spent much of the last year defending and explaining my illness.”

Every two weeks, I take an hour-long bus ride to the psychiatric unit on the edge of town. The bus is always empty; I settle into a seat and crack the window. I try to read, but reading has become more difficult this year. I usually end up staring outside, letting the rowhouses and hydrangeas drift past.

I notice the ripples on the water as we pass the reservoir, industrial yet ethereal. It reminds me of swimming in Lake Michigan many summers ago — floating on my back, the city skyline pressed into the background. I bet the reservoir tastes metallic. The bus hits the same rose bush every time. Today, petals come through the window and pool in my lap. I stuff them in my purse as I pull the cord and stand up to leave.

I come here to meet with my doctor, the woman who has overseen my care for bipolar disorder during the last year. I’ve spent six weeks total on the seventh floor of the hospital over the course of the year as she adjusted my medications — an infuriating, imprecise game of trial and error. Lithium. Seroquel. Depakote. Zyprexa. Lamictal. Abilify. Latuda. Six weeks of standing in a bleached hospital gown, pacing the halls, looking out over the treetops, desperately wanting to lift my brain out of my skull and pitch it through the glass, into the woods. Let hikers find it.

While it often feels like my adversary, I’ve spent much of the last year defending and explaining my illness. People don’t understand what bipolar is, and stigma runs rampant. On one hand, people use it conversationally to mean flighty. On the other, they use it to mean dangerous, alien, inhuman. Neither usage is accurate. Bipolar is characterized by drastic, unusual shifts in energy and mood, ranging from mania to depression. In addition to energy and mood, bipolar affects sleep, appetite, self-esteem, libido, cognition. It runs in families. It is a spectrum, and people are diagnosed with different types of bipolar. Bipolar has nothing to do with finicky weather or pickiness or a sudden change of mind. It doesn’t mean you have “multiple personalities.” It is not an explanation for moral bankruptcy. It’s a serious mood disorder. It’s an episodic illness.

Still, people have trouble understanding. Even one of the psych techs on the ward wanted further explanation.

“You have bipolar?” she asked as she wrapped the blood pressure cuff around my arm.

“Yes.”

“You don’t seem like it.”

“Well, I do.”

“And it makes you feel really bad?”

“Yeah. Right now it does.”

“How so?”

“The depressive episodes make me suicidal. They make me sleep too much. My emotions get the best of me and they come out in strange ways. But my manic episodes can make me feel really good. Sometimes I feel like a superhero.”

I thought about my recent mania, the gifts it brought — the thrill of my sleepless nights, my productivity, sky-high self-esteem, the pile of new projects I’d loved briefly and would never be able to finish. And what depression brought: death, foul and mealy. Depression presented death as a gift. The small, soft rodent corpse. I held it in my hands. I smelled it. I gave it back.

“So it’s kind of a blessing and a curse, I guess, huh?” she said.

“I’d give the blessing away in two seconds if someone offered me the cure for bipolar.”

She ripped the cuff off. Our conversation was done.

“You’re good.”

In my room again, looking down at my socks, I wondered how I was supposed to explain something so all-consuming in such a short period of time. How do you explain what it’s like to live in a mixed state, when depression and mania occur simultaneously? The jittery, agitated energy coupled with suicidality, guilt, irritability.

How could I have conveyed that when I’m unwell, my emotions become more volatile, more likely to overflow — but not in a depraved, serial killer way?

How could I have helped her understand the cognitive effects of the illness, how it sometimes leaves me unable to read or write well, or how medication can derail your life with debilitating side effects, then piece it back together once they subside? Did I accurately convey that bipolar affects my life every day but that I do have a normal life? That I do have periods of stability? Did I seem like an average person? I could have done more. I should have told her more.

Each time I get better, each time I leave the hospital, a nurse walks me down to the clock tower with my belongings — pillows and blankets, flowers people brought, projects I made in art therapy. I look up at the seventh floor as my husband pulls the car around. I leave people behind each time — people I’ve met in the unit, people who have seen me at my most vulnerable. And each time, I vow to help people understand them, to help others learn about bipolar and schizophrenia and borderline personality disorder and mental illness in general.

Days later, tangled up in side effects and symptoms, I feel immense guilt. I need to do more to help people understand. I’m not doing enough. I feel queasy all the time. I can’t wake up. I’m crying three times a day. I need to fight stigma. My doctor gently interrupts me as I ramble and cry.

“The most important thing you can do to fight stigma is to get back on your feet. You don’t have to be the mascot for people with mental illness,” she says. “That doesn’t have to fall to you right now. Get better. You can’t be a good advocate if you’re sick.”

I stop talking. Chastened? No, grateful.

I feel relief as I say goodbye to her and walk back towards the elevators. We’re on the seventh floor. I have to pass by the inpatient unit on my way out. I try not to look, but I always do. The small window shows the tiniest bit of the ward. I see the lives moving inside. People wrestling with their illnesses. Some of them have struggled for years. Some may not even be diagnosed yet.

I am not a mascot, I think. But when I can, I will advocate for us. And I will defend these horrible illnesses — against stigma, against misinformation.

My appointment card gives me a paper cut. The elevator doors close. Rose petals fall out of my purse.

On the way home, I look out at the reservoir. The sunset makes the water look like a sheet of metal, then geese land on it, and it melts. I see a faint outline of the city. For the first time in weeks, my mind drifts away from my doctor, the patients, my illness, my symptoms, how I can make people understand. The bus is moving, but I’m still. And I’m staring into Lake Michigan, quiet and calm.