Anything I initially learned about the body and how it functions was in a biology classroom. I grew to have a tremendous fascination with anatomy and physiology and took up an internship in a medical lab for a couple years, which set a firm foundation for my biology education. Everything I have learned about my brain was in the setting of science. I look at my disorder through the lens of basic anatomical and physiological comprehension, and a long streak of my own medical research using PubMed, the university library and the like. I have also spent a profuse amount of time reading forums of personal experiences written by doctors and patients, and conversing with people who share the diagnosis of bipolar disorder. Doing this has shaped how I understand my own personal experience. From all this time spent trying to expunge everything I can from the available pool of knowledge, I have learned most of all just how few people understand mood disorders and, more importantly, how to talk about them.
Bipolar Disorder, in large part, gets diagnosed through descriptions of subjective symptoms i.e. I go to see a psychologist or psychiatrist (yes, there is a difference) and describe how I am feeling and how it’s affecting my life. In this half of the experience of the disorder, there aren’t necessarily quantitative measuring standards; how one gets diagnosed relies greatly on their ability to communicate and their knowledge of the language they speak. If someone were taught their whole life that they need to conceal their emotions and were never given the opportunity to exercise the language with which they would use to speak about them, odds are, they will be more limited in their ability to describe their symptoms and the understanding of their impacts. Often times, this concealing gets glazed over and called “controlling your emotions” giving them an illusion of fantasy, as if, contrary to reality, these feelings exist as a figment of your imagination and are not to be taken seriously. This is the danger of treating emotions, especially more negative ones, as a taboo subject—you never cease to have emotions, yet you cease to be able to understand them and respond in a healthy way. Unfortunately, this can lead to misdiagnosis or a complete lack of diagnosis.
Please understand that every person on the face of this planet can, and does, occasionally experience similar depressive and manic emotions as someone with a mood disorder. This provokes the reiterated sentiment of “snap out of it”, a technique people not inflicted with a disorder tend to resort to in times of emotional distress, but someone with a disorder will experience these fluxes of moods in regular, mostly predictable cycles. Please also understand that someone without the disorder cannot fully understand the powerful force that envelopes your entire capacity to function, physically and emotionally, to prevent the concept of rising above an intense mood shift. In addition to surrendering to the incapacity to understand, also keep in mind that someone with a mood disorder may not be directly emotionally reacting to a life event but is experiencing a regular wave of mercurial episodes. In other words, if you have an urge to tell someone to “get over it”, there may not be a specific “it” that needs to be gotten over per se; “it” may just be a chemical shift. This is not to say that an episode cannot be triggered by an occurrence, but merely to say that an episode can emerge entirely independent of life events. This is confusing, especially to someone without the experience, majorly due to a tendency to relate personal emotions to dramatic events. Most people, understandably, learn that their emotions are derived from things that happen to them and not manifestations of physical chemistry. This dissonance creates a conundrum; sometimes something described as terrible by a depressed person would not have been described as such if the person were not already dysthymic. Or, turning the tables to mania, something may not have solicited such excitement and energy had the person not been in an up flux of hyperthymia.
Mood disorders reach far beyond the scope of feelings, though; it will alter one’s physical capacity to function as well, a concept constantly misunderstood by people who do not experience it. In contrast to subjective symptoms, someone with bipolar disorder will exhibit a combination of other quantitatively measurable symptoms like sleep patterns, significant changes in weight, record of frequency of recurring mood episodes, reductions of grey matter in the right prefrontal and temporal lobe in the brain, and so on. They will also have a family history for mental illness since it is inherently genetic.
There are even neurocognitive impairments involving executive function, psychomotor processing speed, and verbal memory a person with bipolar disorder will experience that can be quantitatively measured using a test battery (Latalova, Prasko, Diveky & Velartova, 2010). Executive function entails brain processes including working memory, reasoning, multi-tasking, and problem solving as well as planning and execution. Psychomotor processing is one’s motor capacities or physical performance of the body. Studies show that these two functions, and verbal memory recall, are all incapacitated to a degree during stages of bipolar mood cycles. So, in short, what I understand here is that during any given stage of mood fluxes one can exhibit similar symptoms to just about any cognitive dysfunction that exists, from ADD and Alzheimer’s to verbal memory impairment to something similar to nerve damage, to something similar to a learning or social disorder. Impairment in these basic brain functions are considered endophenotypes because, through extensive familial studying, researchers have determined that not only is the patient subject to these drawbacks, but their immediate family is also susceptible to them when compared to people without any history of the disorder in their family (Latalova, Prasko, Diveky & Velartova, 2010). The expression of these impairments correlates with the genes suspected to be responsible for the presence of bipolar or schizoaffective disorders.
To further this idea of neurocognitive impairment, I will provide a specific example from my life: when I am in phases of dysthymia I greatly lose my capacity to draw. My hands are not as nimble as when I am euthymic (or in between phases) and my drawings start to look like they did when I first was learning how to draw. I lose my sense of muscle memory and refined motor skill. My inner dialogue, or the conversation inside any artists’ mind while creating, hinders and it becomes much harder to make concrete decisions about how to transform a drawing above its lines and smears. Even when I force myself to make the decisions, the drawings come out wrong, unbalanced, lopsided, or naïve compared to other successful pieces. My ability to plan the time to set aside and to reason how to best carry out the process of namely making a drawing becomes exponentially more difficult. I think, “Where is my paper… I know I put it somewhere. And where is that damn charcoal!” all the while they are both neatly in their places in front of me in my studio. Nonetheless, after a frustrating half hour of searching, forgetting what I was looking for a couple times in the process, I manage to get paper, charcoal, and the board all set up. Now, if I were to draw a simple portrait I would usually start with something like a gesture and basic allocation of shapes that are present in the image (i.e. a circle for the head, lines to measure proportions of eye-to-head and eye-to-nose-to-mouth ratios, a small shaded pentagonal shape to indicate the shadow of the nose, etc.), but for some reason the short time it takes to look at the image or person and look back at my paper is enough time for all the information I saw to fall out of my head, and then I forget where I was, sometimes I forget what I was doing, and then I give up. If you have bipolar disorder, or any mood disorder, then you have for sure experienced some form of this phenomenon which I have come to refer to as “derp-ression”. If you do not have a mood disorder at all, there is still a chance that you have experienced this. It’s daunting. It can be defeating. It can crush any amount of enjoyment in anything. The worst part for me is that I can only wait it out; any amount of over exertion will lead to a debilitating lowering of my self-esteem which can potentially kindle an emotional depression and exacerbate the dysthymia.
Given my simple example, you can probably imagine a time when you have had this sensation. Whether it brief and isolated or recurring, you are officially aware of its presence. Now, pull this instance and blow it up like a dirigible, and imagine being inside the great big balloon. Imagine that almost everything you did all the time gave you this obstacle except for maybe a euthymic week here and there while you are transgressing one stage to the next. Inside the balloon of your floating zephyr you are suspended in zero gravity, whirring about with absolutely no grab hold and you can’t even remember how you got there, but you can see the little people walking calmly about the suspended basket. I don’t mean to imagine JUST the state of mind; I want you to feel it in your gut, like you’ve been floating in water very still for too long and you’ve lost any control over your body. Now imagine that sensation while typing on a computer making ten times more typos than usual, or standing and trying to listen to someone speak but you can’t understand what they are talking about or how to respond, or walking from one room to the next and forgetting where you were headed every time. Imagine feeling that while lying in bed, immobile, seeing nothing with your eyes wide open. You are not sad, you are simply defective, like a toy whose power switch is turned on but someone cut the wire to its outer circuits. When I am overtaken by dysthymia, more than anything I just want to be one of the people in the basket again, but this overwhelming dissociation in the brain reigns supreme. These time periods make me feel like the atmosphere has thickened into a hyper-stimulating suffocating fume of numbing panic because I can’t put my finger on exactly what is wrong or what’s happening to me, but I can’t shake that my whole body feels dysfunctional. Every part of my day becomes affected. Every part of me shuts down in response.
If you can even begin to fathom this experience, then you are one step closer to grasping why “snap out of it” doesn’t exist for someone with a mood disorder. It’s not just feelings; it is everything you are all at once out of your control for an indefinite amount of time. I need to remind you that this is not an exaggeration. I am striving to communicate the actual, literal experience. If you have trouble believing me then I want you to think about what it means to have broken a bone. I, myself, have never broken any bones. I have only been cut and bruised. I cannot fully imagine how sickeningly painful breaking a bone feels and I will never know until I break one. In the instance you have broken a bone, how on earth can you describe that pain to someone who has not? How many words for pain can you come up with before you understand that most of those words can only be understood in direct experience to that degree of pain? While you may not grasp the full intensity of my description, it is the best I can manage to help you understand that you probably cannot ever fully comprehend, just as I cannot understand the intensity of pain of a broken bone. And get this: I haven’t even touched on the subject of mania!
Now, imagine that the person you sit next to at work experiences what I have described on a regular basis. Imagine how hard they have to work to make you unaware of it even though the experience can be devastatingly overwhelming. Imagine what it would feel like to try and continue to work like nothing is wrong while having a broken arm. Can you begin to imagine what it feels like for someone to tell them that they just need to try harder? That they don’t need help, they just need to be stronger? Can you imagine screaming for help inside the envelope of the balloon and the person who could easily throw you a line just stares at you? If that was the response in screaming for help, how long would you continue to scream?
The answer is simple: not very long. You would probably find a way to make everyone around you feel comfortably ignorant because they will probably avoid you if you don’t. They will probably begin to think that you are trying to dump on them if you so much as mention a problem and who wants to be dumped on? So, you try your best to keep the erratic away from anyone and save it for when you are safe at home out of the scope of judgment. You might spend hours staring at a wall, or a TV that you aren’t hearing, or repeatedly bashing a brush into the side of you head to try and misdirect the dissonance, or smoking or swallowing whatever recreational drugs you can get your hands on. You may even indulge the addiction to slide a razor across your palm, or your thigh, or the part of your shoulder you can’t see under a shirt, or the side of your face in your hairline just to force your body out of its petrification. Anywhere that no one will suspect, anywhere you can relish and feel comfortably secret. Like I said, you may conceal your emotions from the world, but they will inevitably manifest in some way at some time. Thus, in the absence of a helping hand, a capable professional resource for assistance, you get pushed to an extreme. Without a working vocabulary, and an assist that understands it, you become trapped.
Not knowing this information, not understanding it, not recognizing what to do with it or how to act, is not anyone’s fault in particular. I have been diagnosed for eight years, and I am only now getting to a point where I can understand this and communicate it with some level of effectiveness. This is something that directly impacts most of my functioning life. If you don’t have this disorder, why would you have any reason to even think about it?
And that is OK.
What is not OK is acting like the people around you aren’t experiencing something traumatic just because you don’t experience it yourself. I am reminded of an ongoing debate between which is worse: being kicked in the nuts or childbirth. If you can experience one of these traumas, then you do not have authority to speak on how the other feels.
A large portion of unaffected people have a general lack of educated vocabulary and compassion for people with mood disorders, which leads to a great deal of stigmatizing. I think men with bipolar disorder may receive the worst of it because of a ubiquitous cultural standard for men to pretend they don’t have emotions. What more, the problem can become worse if you manage to be able to imitate some functioning level of normalcy because then you really have no excuse if you break through on your meds, or have a bad relapse; you were fine last week, weren’t you? It often appears that a mood disorder isn’t taken seriously until the person ends up in a hospital after they become completely debilitated. It seems like no one can take the persons word for what they are experiencing until they break—they are either found half dead, if not dead, somewhere from attempted suicide or found wandering around the city half naked with their hands painted purple, shouting about being the messiah.
General fear of the diagnosis becomes a vehicle for denial, too. Countless people I have spoken with, including people without a disorder, are terrified of medical malpractice in terms of diagnosis and treatment. They have horror stories of friends or family who were misdiagnosed and responded poorly to expensive treatments that close to ruined their lives. A lack of reliable, dependable, trustworthy research, in combination with the commercial quality that has become so normal to the pharmacological treatment of mood disorders also accounts for a general lack of trust in the psychiatric industry. Too many doctors have become swayed by monetary incentive for writing prescriptions even in the face of a field of study that shows how much more effective cognitive behavioral therapy can be compared to pharmaceutical treatment (Latalova, Prasko, Diveky & Velartova, 2010). In a field where so much of what we know is mutable, it becomes extremely difficult to place trust in the treatment of a disorder that hardly anyone fully understands. Still to this day, the DSM (diagnostic and statistical manual of mental disorders or the standard book through which doctors diagnose mental illnesses) changes how it defines and categorizes disorders. For instance, it wasn’t until the 1986 update in the manual that homosexuality was removed entirely as a disorder; an assumption that back when the DSM was created seemed entirely reasonable, yet now seems completely absurd. Even some doctors, themselves, are coming to a place where they don’t trust the DSM, and are taking it upon themselves to dive deeper in order to understand how to reliably diagnose illnesses.
Having stated all that, I want to share one more personal experience: There was a day back when I worked in a busy coffee house in downtown Boston that I woke up entirely not functioning. That particular coffee house created an intensely stressful work environment and it got the better of me, and I woke up crying and unable to move. I didn’t know what to do besides call, explain what was happening to me, and tell them that I couldn’t make it, me: the one who was never late to work, who worked late to get the job done, the over achiever. We agreed that I would get there as soon as I could and we’d all figure out how to handle the issue later, but when I arrived I heard my superior in the back on a diatribe about how people need to learn how to control their emotions. They were shushed as soon as the person with them saw me, but the damage was already done. They didn’t believe me, and it didn’t matter how hard I had worked myself before that moment, because to them, I just needed to learn how to control my brain chemistry. Soon after that, I applied to be transferred to a calmer coffee house with a much lower traffic flow, and that fixed the entire problem, but I still can’t get that persons voice out of my head sometimes- people just need to learn how to control their emotions.
Lucky for me, I understand my disorder. I understand how to fix my issues, and prevent mood swings as much as possible, and how to ignore other peoples’ blind ignorance. Lucky for me, that company I worked for had policies about how you can treat your employees, especially when it comes to mental illness. Lucky for me, I grew up learning everything I could, all the words, all the language, all the therapy and coping skills, and that moment rolled right off. But what if it hadn’t been me? What if it hadn’t been that company?
We all need to start talking. We all need to start learning. We all need to accept that we have emotions, that we are all differently abled in some way, shape or form, and we need to learn how to be accepting of one another instead of stigmatizing what we don’t understand. For the sake of everyone’s emotional health, we need to stop thinking that our emotions are not real and vital, and instead learn how to talk about them, and cope with them in positive, healthy ways. It can’t just be a coincidence that when I start talking to ANYONE about depression or mood swings that all of the sudden they get a massive wave of relief. They know that I understand and won’t judge them; I will hear them and accept what they say without remit. Destigmatizing emotions would benefit everyone, and could lead to more affordable, more available, and more transparent treatment for anyone who needs it before they hit an extreme, before it’s too late.
Mentioned References
Latalova, Klara, Jan Prasko, Tomas Diveky, and Hana Velartova. "COGNITIVE IMPAIRMENT IN BIPOLAR DISORDER." Biomedical Papers 155.1 (2011): 19-26. 2011. Web. 12 May 2015.
Genevieve Armstrong is a Dallas artists, illustrator and writer. You can visit her at www.gennarmstrong.com