Consider This

 This post was inspired by my dear friend Sue, a psychoanalyst on the west coast of the US. It was a conversation we recently had where she asked me how I control or deal with being bipolar. She said that my experience was important and that I should write about it. So here we go.

I’ve been in therapy on and off for 50 years. Periodically I return to therapy when I need to tease something out that is going on with me where I want a second voice. In another conversation with Sue I asked her if someone could be given a diagnosis at one time and with therapy work through and out of that diagnosis into either another diagnosis or to more awareness, self reflection and control over the things that led you to therapy in the first place. She responded with an emphatic: Yes. Think of it this way: A diagnosis helps to focus your awareness to go further towards your healing and self awareness; gathering self respect along the way. Your awareness expands within the diagnosis and with that expansion of awareness the diagnosis may change.  

Specifically for me, I feel certain there are no more leaves to turn over. I mean I have discussed all my traumas so I feel done with the excavation of my life. I more fully understand my triggers and where they stem from and more importantly how to recognize them and then what to do with them. In the past, the distant past, my triggers just sent me on whirlwind types of emotion misdirected at times, mostly self directed, sometimes suicidal. While I feel done with the excavation what remains is a lifelong project, the perpetual homework of staying on top of the triggers. Triggers may pop up at anytime but it becomes easier to link them back to what you already know. I will never be done with learning.

I spent decades unable to sleep. I spent decades filling diaries with page after page, year after year, just wanting to die. I was a miserable young woman who felt as though my inner life was like a pinball machine. Balls, emotions just bouncing all over, bells going off and never knowing where I might land. So after all those years of therapy I still couldn’t figure out why those emotions-- that were actually physical in my body,-- wouldn’t go the away. It was maddening. 

The turning point for me happened in Vermont. I began therapy again and went weekly for five years. It was the longest I’d remained with one therapist. Let me interject here that not all therapists are created equal. I’ve had therapists that didn’t bother to tell me they were leaving after three sessions, racist therapists that told me that black people don’t do this or that, but mostly, therapists that couldn’t keep themselves out of the session turning the session into my having to listen to their problems. Finding a good therapist takes time. Look for a good fit. It's absolutely okay to interview a potential therapist first. Think about what's important to you. Think of questions that are important to you: Does gender matter to you, do they have a specialty? How do they respond to your questions? For example a therapist that has a specialty in children may not be suitable for you if you are looking to work through trauma, equally said for someone with a couples specialty. Look for a therapist you trust in your bones, not because they have a plaque hanging claiming they have a degree. For me a therapist should feel like the parent you never had. Someone sturdy, consistent, two steps ahead of you, and leaves their own lives out of the session.

In Vermont I found a therapist who was listed in the Yellow Pages under 'pastoral counseling'.  My instinct told me that this type of therapy would likely not guide me in a self-centered, 'me'- first therapeutic approach. I wanted to get better with my sense of morality and responsibility to others intact. I needed to remain aware of the world around me and the various people in it.

I had experiences with this therapist that I’d never experienced before within therapy. I was able to therapeutically use him with transference issues. Transference in a therapeutic environment is a prized moment in your relationship with your therapist. It occurs when enough trust has been built between yourself and your therapist, so much so that you are able to express to the therapist, (who very well may trigger you in some way), what you never felt safe enough to say during your original trauma. Let me give an example. Each week I waited in the waiting room for my scheduled appointment. Each week I could hear my therapist leave his office, heading for the waiting room to come and greet me. Each week I sat there anticipating his opening of the door to the waiting room and each time he entered I jumped out of my skin. I knew he was coming, I could hear he was coming and each week it was like a python was thrown at me. I felt terrified each week. This went on for maybe two years. One day, like all the times before, he entered and I completely lost it. I waited until we got into the therapy room and I ripped into him asking him why the fuck he had to come into the waiting room like he was after someone. His entrance felt invasive, terrifying, and I wanted it to stop. After listening to my apoplectic rant he simply asked what it reminded me of and I began to weep uncontrollably. In my wee years brothers and mothers frequently barged into my bedroom unexpectedly, only to dish out, out of thin air, violence and terror of some kind directed towards me. The transference in this example is that the way my therapist entered the waiting room triggered a memory of a feeling in me. As a child I could not expect or count on those more senior than me to provide stability or the respect of boundaries. I felt like a sitting duck.  Doors opening with uninvited people always brought terror to me as a child. My therapist became the adult(s) I had no control over as a child. My therapist became a safe person for me to finally say what I had always wanted to say to the brothers and mothers of my youth. I transferred this ancient feeling, this memory to my therapist. Doing so opened the door as to why I seemed to jump out of my skin when others didn't. It helped explain why privacy is so important to me and why unexpected guests are rarely a nice surprise for me. Once I was guided towards the source of this trauma I became aware. The trauma was no longer dormant in my subconscious. It was abruptly brought to my consciousness. Once trauma moves to a conscious state you can then begin to work on the tangible rather than the unknown. You become more aware of self and build self respect. 

(When I use the phrase build self respect I mean it in this way: When we are deeply troubled, depressed, insecure, intimidated, uncomfortable in our own skin, attracting dysfunction, when we wander through life wondering 'why' - when we are unconscious as to why things are so, we lack self respect. We re-traumatize ourselves and our traumatized selves traumatize others. Sue worded it this way: With trauma we become the oppressor (of self+ others) and the oppressed (of ourselves)).

This therapist was also the first therapist to ask me if he could refer me to a psychiatrist for possible medication. That began the too long, yet understandably long road to a bipolar diagnosis. I write that it was too long but I understand why bipolarity is often difficult to diagnose: no one seeks help or therapy when they’re manic and feeling great. We go when we are miserable and when we present ourselves to clinicians as depressed they hand you a prescription for an antidepressant. Things have vastly changed over the years though. When I read the symptoms of bipolarity in children -- a relatively new idea that children can be diagnosed with bipolarity--I can look back to my own childhood and I see myself. 

So my first visit with the psychiatrist, among the many good questions she asked, she suddenly asked me if I was itchy. Itchy? My jaw dropped. I was itchy 24 hours a day since the day I entered this world. There has never been a day in my life when there wasn’t a rash on my body somewhere. She prescribed a medication, way off -label, so off label that I couldn’t find one research paper on it being used in this way. But it achieved two things. I finally slept at night and I stopped itching. I was a happy camper! But the moment I moved from Vermont back to New York State no one would prescribe that drug to me because no one had ever heard of it being used that way. A few times I drove to Vermont to get it but it became fruitless and frustrating and I stopped taking it leaving me back at square one. 

I won’t be mentioning any drug by name in this piece. If you really think I’ve written something that’s moved you, then email me. 

No medication, but emotional tools under my belt. So what’s a girl to do who is smart but can’t get her meds? She takes up the life of a wino. 

I drank to control that fucking pinball machine inside. I drank so much that one day in decided I wanted to drink rather than show up for my job. My job had other ideas and put me in rehab. God bless employee assistance programs. I was sent to a mansion, Smithers Rehab on the upper east side of Manhattan, and got sober in style. But I learned an important thing there. I learned all about alcohol and abuse. I learned that that thing that had happened to me as a child had a name and its name was sexual abuse coupled with terror. But so what? I had the info, knew what to do, but it still didn’t stop my pinball and flush of emotions. I just became more aware. But this is important. Sober, I began to really notice and pay attention to certain situations, certain types of people which caused something inside me to physically feel like something was suddenly flooding my insides that all I can say felt like a sudden drop in an elevator. My whole body felt like a funeral inside. Like I was drowning inside from tears; an internal perpetual funeral. Tears and panic. At its worse it felt like I had to move aside for it, like I had to disappear until the feeling subsided. This was, and still is, the way I feel headed for the down side of bipolarity.

A decade or so more passed, sober, but that feeling wouldn’t go away. Then I got arrested and thrown in jail. I’m not going into the details here but no one died and I was only in there for less than 24 hours. But my punishment was to go back into therapy which beats Rikers Island so I was eager to go. Five sessions in and I began getting psychotic. I stopped sleeping, eating and began showing up at work at 3am. I felt great! I didn’t need sleep anymore, food was forgotten about, and I felt great. And then I didn’t feel great. Then I cried while I slept, I cried sitting on the bus to work. I cried my guts out. The front of my clothing was always damp from tears and snot. And then I got into my car and drove to the George Washington Bridge to hopefully run my car into a semi and go off the side. My job happened to be at the GW Bridge and my dear friend wouldn’t stop calling me while I was driving up Riverside Drive. After several calls with my hanging up I screamed into the phone: Why are you bothering me? I had already told her my plans and she finally said out of desperation something along the lines of: Go kill yourself but could you just go to your job and get breakfast first? At that moment it seemed a reasonable request to give someone who meant so much to me. So I went to my job. She then called me and told me to go talk to someone but I was there long before the clinic opened and I was the only one there. I was at a new clinic under new supervision but I worked alongside a clinic I had worked with years before with a crew I knew well and loved dearly. I typed an email to my former supervisor which read: on a scale of 1-10 for suicide I am at 15.  And then I waited. I fell to sleep. The clinic opened and I had to attend a staff meeting which I cried through. And then Alice, my former supervisor walked in to the meeting, took me by the arm, shoved me into Margaret’s office (one of the dearest woman walking the earth), who then took me down to psych ER. 

I spent the first two days on the psych ward writing copious pages about killing myself. They had given everyone a notebook when coming onboard in which to express ourselves . It took me two days to remember that I had been told that if I couldn’t sleep I could ask for meds. After two days of no sleep, and being in a room with a sleeping peacefully roommate I finally went to the nurses station and begged for something. I don’t know what they gave me but I slept straight for days. I slept like the dead and no one demanded that I get up and engage with any activities. And then I woke up and saw that I was on a ward with a bunch of people just like me. What I mean by this is I had vision of One Flew Over the Cuckoo’s Nest. Where were the droolers and the lobotomy scars? Why no bodies in the hallway going and coming from electric shock treatment? I had to ask why the ward wasn’t like my fantasies and I was informed that they separated diagnosis’s. Schizophrenics with their pals, bipolars and borderlines with their pals— no one trying to get well with different types of energy running amok. I was on a ward with my kind of people! Artistic, sensitive, smart, funny, not prone to yelling or violence— the kind of people that had I met in a cafe, I’d be pleased as punch to engage with. It was a picture of the normalcy of mental illness. 

And this is where I finally, finally learned I had a chemical imbalance. That dropping elevator, that pinball sensation was not because I hadn’t uncovered some trauma in therapy it was because I had a valve inside me, that was releasing and closing a chemical in my body that I had relatively no control over. After a trial and error as an outpatient a medication was given to me that did the trick. For the very first time I felt whole in my body. Whole isn’t the word I’m looking for. I felt complete, sturdy, clear. Like I wasn’t rattling inside anymore. That only took a good 45 years.

Here is the important crucial part. I am bipolar but my decades of therapy revealed what my triggers were. Years of paying attention made me aware of my physical body change when presented with those triggers. When I submit to those triggers or don’t catch them in time I can head towards a rough time for everyone, but if instead I take care of myself I can significantly alter the course and the intensity of my cycles. For example my mania, the up side of bipolarity, presents itself as what I refer to as my Marie Antoinette phase- I run around saying things like: Off with their heads! I want to leap over counters and wrestle customer service people to the floor. Telephone calls, make me want to mind fuck the caller. I become short tempered and nasty in my mania. And then I get depressed. My depression begins when I start tripping on things; my legs begin to feel too heavy to lift a foot. I physically begin to move slower. My speech, my reaction time everything become glue-y. I slow to the point that holding myself erect becomes seemingly impossible. I can’t do it and I go to bed until it passes. This is taking care of myself. Normal depression means you can call a person up, invite them out to cheer them up and they feel better for the effort. A chemical depression means your good intention feels like a request to climb Mount Everest naked. I have to let that wave of chemical infusion in my body run its course and leave. Trying to avoid my depression only makes it linger longer. Acting on my mania only makes me fly into the cycle even more hyping me up and having me looking around for innocents to demand things from. I turn into someone in need of unnecessary revenge. 

There are those that believe controlling bi-polarity is a lost cause and while that is true on some level I firmly believe that bi-polarity without therapy, without a keener understanding of one’s triggers really aggravates one’s cycles. I would almost bet that cycles begin with a trigger of some sort. For me identifying that trigger as soon as possible— literally taking the time to just sit with a feeling and figuring out what the upset is— greatly reduces the intensity of my cycles. When I can feel my imbalance, that chemical beginning to bubble, if I can quickly identify the trigger, I feel like my chemicals begin to immediately settle back down. Nothing goes away, it just doesn't go into psychosis. I can't change the depression but I have changed how I feel about it. Where once it felt like a reason to contemplate suicide I now know it is a feeling which will eventually pass and while I'm down I may as well take care of myself because as corny as it may sound, there will be brighter days ahead. It's just a feeling and feelings don't kill you, they just make you feel down for a time.

So why do I think I’m bipolar in the first place as opposed to a schizophrenic like one of brothers? Well firstly (here’s a quick lowdown. https://www.nhs.uk/mental-health/conditions/bipolar-disorder/causes/) bipolarity is thought to have a genetic factor it being one of the only mental illness that can be genetically passed down and two I can raise my hand to having experienced severe, sustained and prolonged terror. On my father side there was mental illness and my mother was mentally ill. Though I am by no means a clinician I would say each of my siblings suffers from some sort of mental illness ranging from personality disorders to schizophrenia.

Children are stretchy, like rubber bands. But they hold onto stress in different ways. Sometimes it gets stuffed away, sometimes they become a bundle of acting out, sometimes they implode. Sometimes the reality of their situation is so overwhelming that they disappear and invent their own reality. I was fully and completely stressed out as a child. I was exhausted most of my childhood. I felt looming terror at every turn but even though I was a child I instinctively knew that it wasn’t me. That there was something seriously wrong with my mother and I maintained hope, like a child thrown overboard with nothing but a raft and no land in sight, that one day I would find land. Well I did find land but one lands after these types of ordeals touched in the head and traumatized. Everything you've learned during war and the tools you learned to survive needs undoing because you land under the notion that everyone and everything is just like your trauma and you have only one type of paddle that you know how to use. Healthy, normal people seem alien. You don’t trust because you’ve never had a reason to trust. All that bottled up craps needs untangling and systematically looked at and then placed on a shelf so you can always see it clearly but no longer have use for. Getting untangled doesn’t lead to perfection, it leads to self identification and understanding not only one’s trauma but also where it stems from. How you learned to defend yourself during war is not useful or applicable once the war is over. We have to learn how not to use traumatized survival techniques in not traumatizing situations. For me that comes down to constantly redefining and setting up where my boundaries are. Setting boundaries are a never ending chore that I do daily. Boundaries are usually robbed of children when their parent(s) or others are wildly inappropriate. Setting boundaries takes enormous courage and is a daily necessary chore for my sense of safety in the world. 

My stress was so intense as a child, and then as an adult figuring out stuff, is what I believe caused that valve to open and shut so many times that the valve wore out releasing, at inappropriate times, a chemical into my body. I lost my elasticity which may seem like a bad thing but something (me) that can endlessly roll with the punches, so to say, really is an entity that is at the mercy of what other people want to do to you and rolling with the punches I don’t think anyone can say is an attribute that has many boundaries. When I think of my schizophrenic brother who suffered the same but different traumas as myself, I think he just imploded from the stress. He didn’t have the reserve of hope that I did, nor the denial of my other siblings. Denial keeps people afloat too. 

While writing this piece Sue asked me what the source of my hope was, what kept me going? It was, in part, the book, Anne of Green Gables and its main character Anne Shirley. Throughout the decades I thought of Anne and what she might do if she were in my situation. She had pluck, verve and an imagination that emotionally projected her to were she imagined herself to be. That same imagination allowed her to create a mental environment which vastly differed from the dire circumstances she found herself in. During the worst of my abuse I was living on Prince Edward Island in the Canadian Maritimes. Pictures of Queen Elizabeth were everywhere and she seemed to look down on me with such tender and loving benevolence which I imagined was solely for me When I was depleted of hope I imagined that she was really my mother and that one day she would lay claim to me as her very own child. (I cried more when the Queen died than with my own birth mother's death). That book and that picture kept me going. I just had to get past, get through and I was sure that on the other side would be angels and calm to take care of me and guide me. As Sue suggested: I found an image that protected my ability to love and be loved. Sue was one of my earliest angels. 

I worked like a slave for myself. I want anyone reading this to know that the work is hard and never ending to be whole but the reward of survival of over coming, of leaving things behind, of letting go, of feeling safe, of creating boundaries, of having friends that really love you, of seeing the weaknesses of, and having empathy for those that just didn’t know better, that there will be so many wonderful rewards given you that all that pain will become something you used to do and feel. But it takes hard committed unwavering work. I often think of The Shawshank Redemption. Andy Dufresne crawled through a tunnel of unspeakable shit to finally be free. It takes years to internalize abuse and it will take years to disentangle yourself from it. We didn't get fucked-up overnight, why would we think getting well would happen overnight? My goal in my life has been an attempt to discover who I am had I not been indoctrinated by my mother.

Don’t let anyone tell you that true forgiveness means you return to the same pit you crawled out of. It just means you let it go in your heart, forgive the person, and keep on stepping. Forgiveness is all about you letting go. It has nothing to do with the person you're forgiving. People who tell you such nonsense are people who want company in their misery.  I let go of my mother decades ago. She's as vague to me as any toy I may have had as a child. 

But now I am faced with the same difficult choice with my siblings. I can't help them and I no longer know how to step inline with the family dynamic we grew up with. With my cancer diagnosis I am sure of one thing: I will not spend my remaining time on this earth trying to fix broken things. I feel such tremendous sorrow for them and oddly I believe they feel sorrow and love for me but it gets lost in translation and can't be expressed. Each in their own way expresses their sorrow indirectly in passive-aggression, bullying, astonishing insensitivity, and a misogyny I can't abide by. I am their sister, me, that woman who reminds them of their mother  It is with great sadness that I let them go. Though different, it is the same profound sadness that I had letting go of a mother who didn't know how to mother. I let go of my siblings who don't know how to love a sister outside of bad habits learned to survive their own traumas. I let go of them but they should know that I love each brother because I know they suffered the same trauma as I did. For that I have the deepest sympathy and empathy.

In closing there is no end to practicing awareness. No end to looking for understanding of self and others. The never ending search is a type of hope; it propels me on to know more-- to see how the pieces fit together gradually and more securely placing me squarely in this world which I live in with others.

Hope is the thing with feathers

That perches in the soul,

And sings the tune without the words, 

And never stops at all,

And sweetest in the gale is heard;

And sore must be the storm

That could abash the little bird

That kept so many warm.

I've heard it in the chillest land,

And on the strangest sea;

Yet, never, in extremity,

It asked a crumb of me.

--Emily Dickinson 1830-1886