Your Stories

by Simone Brooks

I was asked to give some advice to those of you who are newly diagnosed with bipolar disorder and your loves ones. My focus is really on those of you who have been diagnosed; although, my hope is that you loved ones will learn a little something that will help them you understand the journey you are on together.

I have three pieces of advice:

1. do nothing to make the situation worse
2. if you fall, and you likely will, rise again
3. strive for the courage to thrive

I was diagnosed in 1993 with major depressive disorder. I was re-diagnosed in 2003 with bipolar II disorder, and finally with severe bipolar I disorder.

I have felt the highs, the rushes, the passion, the sensuality, the energy, the omnipotence, and the limitlessness of mania. I have also felt the desperation, exhaustion, fear, terror, horror, guilt, shame, and despair of depression. And, I have visited the planes in between. I have self-harm behaviors that have scarred me physically, and suicide attempts that have scarred me emotionally.

I have suffered and caused suffering.

Sometimes in the midst of one of my depressive moods, I feel like I am a smaller, tiny version of myself standing inside a larger unfamiliar me–and that tiny version of me is surrounded by darkness and an oppressive heat, gasping, unable to escape, while the larger me plods on, disconnected, seemingly unaffected by the terror of the smaller me. That larger me, disconnected, does not remember to take care of the smaller one: (1) moderate food and alcohol consumption; (2) workout; (3) journal; (4) go to psychotherapy; (5) take prescribed medications; (6) meditate – she ignores my needs until I wilt inside.

What to do with a wilted me? a pain-filled me? an emotionally and physically exhausted me? As if I were a weed, I have tried to extract myself from life through maladaptive behaviors like binge drinking, promiscuity, raging rants, cutting, and even suicide attempts. All of these behaviors made my situation worse:

• causing my health to become at risk
• causing my doctors to try new medications when just taking the ones I had might have helped
• causing wounds that made strangers stare, me feel ashamed, and further distanced me from polite society
• causing my friends and family to worry and become overbearing, further smothering me.

These maladaptive behaviors were all I knew, but they risked not only my well-being but my life.

Now, I tell people that I owe my life to Dialectical Behavior Therapy (DBT), a form of therapy pioneered by Marsha Linehan at the University of Washington.

It was initially designed and applied to those suffering from Borderline Personality Disorder, but has been found to be effective with other forms of mental illness and even substance abuse.

One of the first things I came to understand in DBT was this concept of “do nothing to make the situation worse. And, if you can’t stop from making it worse, lessen the damage.” For example, if you are a person with self-harm behaviors, and you desperately want to act on that behavior, call your individual therapist before making the decision. Perhaps you give yourself permission to self-harm as soon as you’re done with the call. But make the call. You’ll likely find that the need to self-harm has passed. You didn’t make the situation worse.

Not making the situation worse doesn’t mean you’ve made it better, it does not mean that your illness has disappeared. Instead you have held your ground. You have remained steady. You have lived to survive another day.

My next piece of advice is that if you fall, if you relapse or have a recurrence, if you fall, rise again. Relapse occurs when you have not yet become asymptomatic. Recurrence is an episode that occurs after you are in remission.

In the world of mental illness, recovery is not and remission rarely is an endpoint, a final destination. At least one study has shown that patients with major depression who experience one episode are 50% more likely to experience a 2nd. Patients that experience 2 episodes, are more likely to experience a 3rd, and those that experience 3 episodes are 90% more likely to experience another. I don’t tell you that to discourage you. I tell you that to prepare you.

The likelihood is that you will fall down. That can be a terrifying prospect. So, while you are up, do the work: psychotherapy, exercise, medication, meditation; do the work to prepare yourself for what is likely to occur. Understand what your triggers are and plan for them to occur again. How will you deal?

For me, with every relapse and recurrence, I learned something more about myself and my strength, my capacity to survive. Each time, I worked to acquire new understanding and new skills to aid me for the next fall. At first, I didn’t believe that I was any different. I felt as if each fall was the same, or worse, more miserable than the previous. I felt that just experiencing recurrences was a failure.

With the help of my psychotherapist, I realized that my recoveries were faster, that my climbs to remission were not so steep.

Thus far, I have continued on. Not a pull yourself up by your bootstraps kind of continuing on. Rather a quiet kind of determination to survive. I read a quote from Mary Ann Radmacher, “Courage doesn’t always roar. Sometimes courage is the quiet voice at the end of the day saying, ‘I will try again tomorrow.'” I try to be courageous.

Speaking of courage, my final piece of advice to you is to strive to thrive. Strive to find the courage to not just survive this life but to live a life filled with contentment, with fulfillment.

Some days, I feel as though this diagnosis I have is a weight unbearable. I have found those are usually the days that I’ve exhausted myself with hiding my bipolar experience.

Kay Redfield Jamison wrote “I am tired of hiding, tired of misspent and knotted energies, tired of the hypocrisy, and tired of acting as I have something to hide.” I understand that in your workplace and your personal life, you may not have the freedom to air your diagnosis or diagnoses, the safety and security to ask for and receive the help that you may desperately need. Perhaps hiding is more than a way of life. Perhaps it is your only method of survival.

But it is when you stop hiding from yourself, when you mindfully, radically, accept that in this moment you are perhaps not in remission, but you have the potential for it. Mindfully, radically, accept that your journey of recovery is in every moment, it is in every choice.

Thich Nhat Hanh wrote, “People have a hard time letting go of their suffering. Out of a fear of the unknown, they prefer suffering that is familiar.”

I believe that each of you wants something different and possibly better. I believe that where you are and how you behave now is understandable given your circumstances (internal and external). But I also believe that you have to try harder even when the reserves seem empty, in order to experience improvement in your condition. And finally, I believe that you cannot fail. I have faith in you. Now you must have faith in you. Live. Strive. Thrive.