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Sinking

In most times and places bipolar disorder was considered a curse or demon. I’m guessing that, against conventional wisdom, it wasn’t ignorant priests or hateful neighbors who came up with that but the bipolar people themselves. It’s such a tragedy that every time you get some relief, that every time you think you’ve figured out how to manage it or keep it at bay it inevitably comes back. It’s even worse if you haven’t fully internalized the meaning of “chronic” or “degenerative.” I knew something was wrong in September, but just because something is wrong doesn’t mean the sky is falling. I realized I didn’t have an outlet for my worries, concern, or pain. I was doing better going to work and getting things done than I have in several years. Far from the intense social isolation I experienced just a year or two ago, I had a growing group of people relying on me for emotional, academic, and professional support. I liked that. But the more I spent my time helping and listening t...
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White Knuckling Through Normalcy

A couple of days ago I wrote On Stepping Back into Life because I was trying to figure out why I was slipping into unorganized depression right when things seemed like they were getting better. I felt better for maybe a day, but -shock!- knowing what’s going on doesn’t actually stop the thing from happening, it just helps us get through it. I still feel like I’m getting beat up. I think the main conflict is, “How can I ever trust myself again?” I tried to kill myself! I certainly wouldn’t trust anyone else who made an attempt on my life, but I have no option but to somehow make amends with myself. After a brief recovery period, you can’t just live your life according to what other people think is best-that’s how you end up in the wrong life and eventually you blow it up to escape. You don’t have to experience suicidality for this. Maybe you made a stupid decision about a relationship, moved to the wrong place, trusted the wrong people. Somehow you ended up alone (either in reality...
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On Stepping Back Into Life

It takes a long time to recover from extended periods of black depression. It’s common to think of suicide like an on/off switch-the battle is over once you stop thinking about killing yourself. That’s not true, it’s just another incarnation of the dreaded recovery myth. If you’re depressed for a year or more, you have effectively rewired your brain. Most of us don’t emerge from that a bundle of bad emotions, we come out numb. Maybe we don’t actively fantasize about suicide anymore, but that doesn’t mean we’ve taken up the cause of life, either. I’ve been in remission for 18 months, and it’s still hard. I’m still surprised by what I lost and what it takes to get those things back. Recovery is a process of stepping back into life, over and over again. This looks different for everyone. I remember the first time I realized it was getting better, about 16 months ago. It was two months after ending a long-failed relationship and six months after deciding I needed to stop medicati...
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When do you walk away from the things that are killing you?

The happiest day of my life was a few months ago when I realized the intense, endless suicidal ideation had stopped. Maybe if I had a setback I’d offhand think “I should die,” but there was no waking up with a plan, dreaming of buying a gun, or desperately trying to imagine something, ANYTHING, in the future. I wept tears of joy. I felt like I had a chance at a life again. But it’s back and I’m devastated. I knew it would come back eventually, but after years of drowning I hoped that I would have more than 2 or 3 months of reprieve. I knew something was wrong. A week or two ago I started to feel the heartbreak. It doesn’t register as heartbreak at first, because that doesn’t make sense if you haven’t lost someone. It’s heaviness in the limbs, weakness in the knees, a sinking feeling in your chest, and basically no frustration tolerance. You cry at the drop of a hat, and your thoughts always turn melancholy if you allow yourself to daydream. It takes a while to realize your he...
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Isolation: Social failure, suicide, and depression

Isolation is an extremely common symptom of depression and often invoked as a warning sign for suicide. At this point in my life, it’s so intuitive to me that I forget other people don’t understand. Isolation is a positive feedback loop; the more someone isolates the more they feel they need to isolate. Let me unpack some of that logic. Maybe you can see these behaviors in yourself and fight against them. Maybe you see someone you care about, and this can keep you from getting angry or personally hurt. It really isn’t about you. Step 1: Not enough energy So, I have one caveat here. I am an introvert; I lose energy being around (most) other people and gain it by spending time alone. I would guess that extroverts have a very different experience of isolation, and I’d like to hear more about that. I can’t find much information on it, but I’d guess that it takes longer for them to withdraw, but the negative effects ramp up quicker. Anyway, for me the first thing that happens is I j...
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Stop Connecting Donald Trump and Mental Illness

I hate every single “Is Donald Trump Mentally Ill?” article. I can’t believe how many “intelligent” people love to call the president mentally ill. It’s stupid and cruel. Stop doing that. We have a group of psychiatrists who think it’s their “duty” to give an armchair diagnosis to the president. Really? If it meets the Enquirer's high ethical standard, why shouldn't trained medical professionals do it? Good news about Cher, though. First, mental illness does not make you a cruel asshole who makes bad decisions. He’s stupid, willfully so. He’s egotistical, he’s selfish, he’s vain. It doesn’t matter if those things are at a level that’s diagnosable as a personality disorder or not. It certainly doesn’t tell us anything about his brain chemistry. He’s a bad person who does bad things. Shut up psychiatrists; if you want to pitch in maybe try helping a real person who can’t afford your services. You better hope I don't run into you in a dark parking lot, page 106....
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The Exciting World of Mood Disorders

Mood disorders, including depression and bipolar, are more common than most physical diseases, yet most of us have a poor grasp on what they actually are. Emotional disregulation is the most obvious outward symptom, but that's just one effect of broader neurological dysfunction. Let's explore the exciting world of mood (or affective) disorders! Doesn't this look like fun?! Traditionally, mood disorders are presented on a model with one axis, like the figure below: Image: Mayo Clinic Euthymia is the x-axis, and mood disorders depart from there, either going high (mania) or low (depression). There is a major flaw with this model, especially when we talk about suicide risk. Recent research has found that most of the time bipolar people are actually experiencing mixed episodes, or moods with both manic and depressive features. The model above cannot represent mixed episodes, leading many to believe they are rare. I developed a different 2-axis model to better rep...
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