IS it me or my meds?

 I’m studying a book by David Karp: is it me or my meds? (Harvard University Press, 2006) I’ve been aware of this book for several years, and finally started reading it a few weeks ago. David Karp is a sociologist who taught at the prestigious Boston College for many years. He’s written or co-authored nine books. I met him years ago at DBSA Boston (Depression Bipolar Support Alliance). He graciously accepted my request to read my memoir draft. His comments were insightful and immensely helpful.

 

I had avoided his book because I had the impression that it was exclusively about major depressive disorder: unipolar depression. To me, there is a great divide between unipolar depression and bipolar disorder. In my humble opinion, the two are very separate afflictions.

 

(I’m losing the culture wars: as you know, I object strenuously to the term ‘bipolar,’ but the American language has moved on and ‘manic depression’ seems to be headed for the same dustbin as ‘hysteria’ and ‘childbed fever.’ But manic depression is actually much more specific and effectively descriptive than those other abandoned medical terms.)

 

Although David Karp’s book is largely about depression, he has plenty to say about psychiatric medication more generally. He interviews fifty people who have taken psychiatric medication and explores the interplay between medication and issues of self, authenticity, and relationships, including the relationship formed with the medication itself. He acknowledges the great positive impact many medications have had on alleviating human suffering while exploring the double-edged-choice I make each day as I ingest psychotropic drugs.

 

And it is indeed double-edged. Medication has allowed me to live outside a locked psychiatric unit continually for 19 years. Most probably it has also diminished my mental powers. It may be affecting my metabolism (higher risk of diabetes) and vital organs (lithium is hard on the kidneys and thyroid.). Over time I’ve learned to live within its restraints. Both diminishment and adaptation have existed side by side for the 26 years since I was first prescribed lithium. Am I married to the medications, as David Karp suggests? I’d never thought of it that way, but yes. In what other sort of relationship entered into as an adult is there intimate contact for 26 years, with the expectation of a lifelong commitment?

Who I am

 I’m going to be controversial here. I don’t mean to speak for anyone else, but I will speak my mind.

A common discussion at my support group, DBSA Boston, over the years is the difference between being bipolar and having bipolar. In introducing myself as a facilitator at the newcomers’ meeting, I soften it even further, saying, I have bipolar disorder.

Most people reject the idea that they 'are' bipolar and opt for 'having' bipolar. But about eight years ago a young woman I know declared, "No, I am bipolar." I puzzled over it, wondering which felt truer to me. At the time I wasn't prepared to embrace her statement. I felt it was limiting.

As research for my memoir,, I just finished is it me or my meds? The author David Karp (whom I know through DBSA Boston) describes a support group meeting:

The meeting began with brief introductions during which nearly everyone said something like, “My name is Joe and I’m a depressive." After all the introductions, a young woman suggested that it would be far better if people said, “Hello, my name is so and so and I suffer from depression.”

A woman David Karp interviewed said:

Every time we take the medication it keeps constructing your identity as bipolar, or as whatever diagnosis, but you know, that is not who I am….It’s not, in any way, the whole of me. It’s a part of me. I am a teacher. I am a writer. I am a lover. I am a woman. [Mental illness] is just [something that] gets in the way a lot.

I have no intention of constructing anyone else’s identity, but lately I’ve been thinking that I am bipolar. (I actually hate that term, but for different reasons than the usual. Manic depression is so descriptive in a way that bipolar is not. I’m not a toy magnet, I don’t consist of two poles. I experience mania and I experience depression. However, I don’t particularly like the term ‘manic depressive.’ That does seem reductionist, as if I am totally in the thrall of those two states. I haven’t come up with a better noun (please suggest some), so for now I’ll use bipolar.

I checked out Word Hippo and found 273 (yes, I counted them: slow-news day here) adjectives for "vacillating between two extremes" and 49 "involving or having two extremes." Nouns are bipolarism, bipolarization, and bipolarity. I suppose it was too much to ask to web-search to satisfy me. (Give it a try, Matt. I so loved wrenmimic!)

Certainly when I’m psychotic or in a debilitating depression, there is something wrong. My life would be better, I could be more productive, better at relationships, if that didn’t happen. But the tendency to mood swings, the highs and lows (the 7-out of-10s and the 3-out-of-10s) seem to be ingrained deeply into the fiber of my being. The woman David Karp interviewed identifies herself as a teacher, writer, lover, woman. None of those identities is the whole of her but they are deep parts of her. They are parts of her identity. My manic depression isn’t the whole me, but it goes deep, very deep.

For the curious, Word Hippo suggests:

volatile, mercurial, oscillating, vacillating, capricious, spasmodic, undulating, two-faced, variable, unpredictable, changeable, unstable, erratic, inconstant, fickle, impulsive, tempermental, flighty, fluctuating, inconsistent, whimsical, mutable, fluid, unsteady, irregular, changeful, uncertain, unsettled, skittish, wayward, flickery, flakey, quicksilver, flaky, blowing hot and cold, irrepressible, wavering, excitable, protean, kaleidoscopic, moody, giddy, labile, active, movable, elastic, up in the air, unreliable, up and down, ever-changing, mobile, yo-yo, up-and-down, undependable, fitful, arbitrary, changing, random, varying, jerky, desultory, quirky, freakish, faddish, ungovernable, wild, haphazard, chance, vagarious, crotchety, constantly changing, ephemeral, shifting, transitory, frivolous, momentary, fleeting, peaky, short-lived, transient, impermanent, full of ups and downs, uneven, fluctuant, aimless, hit-or-miss, indiscriminate, unmethodical, casual, intermittent, chameleonic, sporadic, turbulent, along with waffling, fluky, directionless, orderless, blind, lost, reckless, offhand, iffy, sketchy, unsupported, off-and-on, objectless, quick-tempered, unreasoned, pointless, and more.

Not quite on the mark.

Moodswings

Last week I wrote a high-flying post, full of optimism and confidence. Since then I’ve spent some hours slogging through life. It's not really depression: it’s not the deep dark hole many describe. The self-loathing is absent: I feel a disappointment in my inability to accomplish what seems like reasonable goals on a reasonable timetable, but no self-hate.

 

This week, as my attitude towards my life has swung from optimism to, not pessimism exactly, but disappointment, I’m left wondering: is manic depression deep in my nature? Is it an essential part of my personality? Is it as immutable as my eye color and height?

 

I think it likely all of the above.

Yesterday morning I woke feeling discouraged. Monday is the day I have few outside obligations. When David was sick and I drove him to the Cox Clinic twice a week for leukemia treatments, I made no other commitments on Mondays and Thursdays. After he died, I promised myself I'd continue that schedule. Gradually obligations, freely entered into, crept back into my Thursdays, but I’ve kept Monday free, a ‘stay-at-home’ day. Each week it spreads before me like a field of freshly-fallen snow waiting for my imprint. And many Monday evenings I feel keenly a lack of accomplishment.

 

What if I accepted the ebb and flow of my moods as a part of me, just as the tides are part of the ocean? When I visit the shore, I don’t resist the tide, I carefully survey the beach for signs of the high tide mark, where the sand is completely dry and never drenched in saltwater. That’s where I place my blanket. If I've arrived at high tide, the surf is near the blanket, if low, I must walk a bit to enjoy the waves.