Writing Bipolar (from a Bipolar Writer)
I have been, from the age of twelve, been bipolar. It was only recently that what we thought was depression was diagnosed as Bipolar II, but I have for the majority of my life suffered from this mental disorder.
And now I'm going to tell you all about it. Not because I want to vent (although, you will see, I do so), but because I feel that too few writers write about bipolar disorder.
I've never quit a book due to a misrepresentation of bipolar disorder, although I've winced a few times. This is possibly because there are so few books with bipolar characters in the first place. There is still a stigma to mental illness, after all--I hardly introduce myself as "Matthew P. Schmidt, the Bipolar" If, for no other reason, that I have gotten tired of people's reactions.
But you, the writer, have decided to write about the peculiar mix of Hell and false heaven that is bipolar. Good luck. Here is an attempt to describe what it even means. You, the non-writer, are also welcome to see, if you could, from the inside.
I must note before beginning, however, that this is my own experience. With every condition like this, each individual varies.
0: It's a lot more real, and frightening, than your readers will believe.
At the fastest I've ever cycled, guess how frequently I went from EVERYTHING IS GREAT 130% LET'S GO to utter, suicidal misery?
Every day? Every hour?
Answer: About twice a minute.
If this sounds unbelievable to you, guess what? It's entirely true. I would rocket back and forth between extremes in the middle of a single conversation. One word or thought and I would be dragged one way, and another and I'd be dragged the other. Since I've been on Tegretol, it's not been nearly as bad--but it once was!
But this isn't to say all bipolar cycles that fast. Sometimes (and I have experienced this myself) a mood will last days--days of depression, punctured by brief moments of pure bliss--irrational, meaningless, but a kind of bliss nonetheless.
This is also ignoring the depths of the extremes. While I have been in depression so great I cannot imagine Hell to be any worse, I believe my up moods cap at what's called hypomania. I have never gone so far that I went online and bought everything I saw--but that is one of the signs of manic-depressive disorder (bipolar I).
But consider, writer, whether your reader will tolerate this level of mood swing in a character. Consider if you will tolerate this level of mood swing in a character. If you can't, chances are any depiction will be some watered-down safe-for-mind subsitute. The sort that makes me wince.
1. There's no control. There is only coping.
The nature of any chronic condition is that it's chronic.
If you write a character with bipolar, and wish to be accurate, they must ALWAYS be bipolar. There is no convenient off-switch to press when tired, or when it is inconvenient--or when you are sick of life with bipolar and wish it all to end. There is no relief, no escape, nothing but your own self--and what you can fight in this war without cease fire or surrender.
The worst of wishful thinking, no matter how strong the wish is.
The nature of any chronic condition is that it's chronic. There is no time that is safe from a mood shift. You could be having the time of your life, a great personal triumph--and start feeling miserable. (Or, as I often have, nothing at all, as if all good and beautiful things are lost and never were, the lotus eaten and now dust in the mouth.) Or, you could be "supposed" to feel sad for some reason, and find yourself too "happy." Or you could be going about your daily life and rocket to one extreme or another. There's no logic behind it. Nor is there an end.
Did I mention the effect on other people? I have found it impossible to meet other people's social expectations of what emotion to feel when. As such, I don't try, though I feel guilty for not doing the impossible. Nor, for that matter, do I go telling others how I feel that often, for I have gotten sick of sympathy. Even the question "How are you feeling?" is rarely possible to answer without a long explanation that ends in "I don't know what to tell you." There is no other option, there is no "opt out".
And do not believe in some easy cure by taking a pill, or saying a prayer, or taking up some practice. While it is not one bit more difficult for the LORD to cure a disease than to create the universe itself, He is not some vending machine. I believe in Divine healing, but for a character to be healed at a convenient time would result in a thrown book.
(After all, the voice asks, why not I?)
2. There is no line between you and the disease.
This, I think, is the most important thing to get right.
Some users of E-Prime would say that I should not call myself bipolar, never say "I AM bipolar." While I appreciate the thought, and have sometimes given lip service to the idea so that others would not find me strange, or even out of hopeful thinking--it isn't the case. It does not match my internal experience at all.
That is, I have no shiny black line between my "own" thoughts and those caused by my bipolar. To say I don't "feel" the surges of emotion would be ridiculous--and how can you feel anything but your own emotions? I do at times feel as if it is another version of myself, twisted perhaps--and yet I can no more call this other version someone else than I can call you "me." I cannot say that it is another who wants suicide, or another that feels everything ever is the greatest it has ever been and ever could be.
And thus, perhaps, the stigma to mental illness. What does it mean if you can't even trust yourself? To say that the line between what is you and what you reject is invisible--if it could be made at all--is not a comfortable subject. (After all, if this disease in myself is cancer, what if others have colds? Or typhoid?)
The logical consequence is that your character must not wake up in the middle of the night and say "Oh, look, I have some thoughts that aren't my own, clearly I have bipolar. Off to the doctor!" Chances are, his feelings will appear totally normal to himself--as your own feelings appear normal to you--until he realizes that his emotions are not rational.
And that is precisely how one can (if possible) separate the two. I am usually aware--when I am not feeling the height of either emotion--that the extreme I am feeling is not warranted by the situation, or any conceivable situation, and therefore it is irrational. Congratulations! But to know this requires being rational in the first place, a task quite difficult when one is already irrational. After all, there's no magic black box of safety into which to conveniently retreat.
3. (hypo)mania is not good.
Not remotely accurate.
Perhaps I'm going to offend someone by saying this, but bipolar is not switching from being happy to sad, 50% of the time being spent on each. It's switching between a number of emotions, but the great highs and lows are mania and depression.
When I was younger, people would say I would get hyper. In retrospect, I believe I was simply hypomanic.
What is it like? Going at 120% constantly, with so much energy you can't even help from kicking your legs. Feeling as if every evil and bad thing was only an illusion. Wanting to do everything immediately, starting a hundred new projects, just about bouncing off the wal--
And then you flip back to despair. Because, remember, you have no control.
4. Medicine helps (or not) and then you change it.
I know this is a divisive issue in the mental illness community (a strange phrase I suppose.) So I'll simply talk about my own experience.
Psychiatric medicine is an uncomfortable subject as well. The idea that a pill changes how you think is not one that one would like to think about too hard. (Never mind that this is literally the effect of alchohol.) It is a stigma of its own in certain religious circles, as if you are weak, unworthy, and require material aid for what "ought" to be curable with sufficient meditation and prayer. (This is not to say that neither helps, but to rely on them to exclusion of material aid is treating the LORD as that vending machine, beseechable with the coinage of ritual and witchcraft. Papists and anyone with the Apocrypha, check out Sirach.)
And yet, I have been greatly helped by it. Tegretol ended the minute-level cycling in one night. Others have simply blunted the edges of the extremes. Still others have just made me feel better in general, or have less down moods, or just feel stable.
But they have had all kinds of bizarre side effects. Or are just bizarre. Sapphris comes in a tablet which you dissolve under your tongue, euphemistically described as "Black Cherry." It is the second-worst thing I have ever tasted, beaten only by accidentally drinking my brother's science experiment. On Tegretol, you are forbidden from eating grapefruit (and it can potentially dissolve your liver). Abilify, I have been told by others, gives (bowdlerized) "screwed-up dreams." The horrifying-sounding condition of orthostatic hypotension (caused by more than one medicine) made me strategically plan every time I got up from a chair, as I would become faint by just doing so.
And, good or bad, sometimes then they just stop working. Or the side effects finally become unacceptable.
I've been on nearly every medicine in a certain category. I am unsure if there are any others. Each of them I thought would be the answer. The one I could stay on. But no, tardive dyskensia. Or no, I am so hungry that I can never be full--and gain weight to match. Or--and I am not afraid to describe this one, as it was working so well--Risperdol's hyperprolactinemia. An elevation of a hormone which would eventually result in a condition best described as MANBOOBS. Off I went--and the next year was Hell. I do not think, no matter how many articles I write, I could describe the torment of seeking a medicine I can stay on.
Before I went through this process, I could not imagine ever consenting to ECT (electroconvulsive therapy). (It's often depicted a lot worse than what it is--another result of the mental illness stigma.) I still have never consented to it. But I can imagine it now, if it was the only option.
(N.B. I am currently writing this during a medicine change. If I sound bitter, there's a reason for it.)
(N.B. x2 As time has passed, the new medicine seems to be working well. But will it last?)
5. You might not be diagnosed properly in the first place.
All of the above, of course, assumes you were on the right medicines in the first place. Something like 70% of bipolar patients (including myself) were at one point misdiagnosed. Antidepressants have the wrong effect on us. While I felt better most of the time, it made the cycles worse.
But how do you know? There's no status readout on your health bar, reading "Bipolar II". For that matter, how do you even know if a medicine is working, or not working, or it's just how you're feeling when you visited the doctor, or that your aunt died, or that therapy helped, or...
While Internet Diagnoses are the curse of a connected age, if this article speaks to you, and you are currently diagnosed as depressed, consider that you might actually be bipolar.
6. Medicine is not enough.
While psychiatric medicine is one of the more dramatic forms of treatment (short ECT and hospitalization), there's also just therapy. Or learning coping skills in general. It is because of this I can realize that irrational thoughts are irrational. I had no one else to compare my thoughts too, after all.
Therapy does help (although again, for some it does not) It's rarely as depicted in media, I've found. For one, I've never looked at any ink blots, nor have I ever been directly asked to talk about my childhood. (If, nonetheless, I have eventually done so.)
But here also is a limit. A therapist cannot fix your brain nor your life. Nor, quite possibly, can you. It may ease the burden, and if you will carry it all your life, perhaps that is enough.
I must also mention that no amount of worldly care can repair the wounds of the spirit, no more than a cast on your leg can fix your heart condition. Had I not spoken to (many) priests, asked for (many) prayers, and simply eaten Jesus a bunch of times, I would most likely be dead already. Such is the power of the LORD, to un-break the irreparable, to pour the Holy Spirit into deep wounds, and to forget sins, as if they never were.
7. It does not end.
Remember this guy?
Still wishful thinking.
There is this thought that at some point, you will have reached the "end." Enough medicine, enough therapy, enough hospitalizations, even, a sufficent amount of prayer. You've collected a hundred million medicine points, all one hundred twenty mental illness stars, got your stamp card stamped in all the right places. Haven't you done enough? Haven't you reached the end?
And for some, there is finally relief. Some. And for some, it lasts.
After a year or so of therapy, and a few medicines, I believed I was cured--of depression. I even ended therapy.
But it didn't last. Some time later, I changed medicines and some time after that, I was diagnosed with mood disorder, and then Bipolar II. Yet, I truly believed it was over.
And can it ever be over?
Do you think I choose bipolar? Would you imagine that it is some failing of mine that I still have it, despite every action I have taken to the contrary? I have thought both those things of myself.
But there is not a cure. There is no magical formula. There is, quite likely, never going to be true relief while I am alive on this Earth. It is quite possible that I will be taking some form of psychiatric medicene for the rest of my life.
I do truly believe this is my cross to bear, for the rest of my life. This isn't a boastful thing (as if one were to boast of crosses) but a realistic knowledge that healing will not come while I am still alive. In Heaven, yes, but on Earth...
Some do have the choice, but the medicine that relieves their symptoms also relieves of them of their creativity. I am unable to decide what I would choose in that situation. As of yet, it is a moot point, for I have never had the choice.
Most likely, I never will.
You, the reader, have possibly freaked out at this point, and those of you who are writers have reconsidered whether your character should really be bipolar. Don't! The stigma surrounding mental disease, I think, is in part because our art refuses to address it, or addresses it wrongly. If your muse tells you your character is bipolar, listen! Even if you cannot do it perfectly, a poor but well-hearted attempt is better than no attempt at all.
Alternately, you might have just realized one of your characters is bipolar and you did not realize it. (This has happened to me before.) I find many depictions of the concept of a tsundere is more like glorified bipolar. (Now glorifying a mental illness would result in a thrown book, but thankfully it's rarely depicted positively.)
Having written this, I'm considering a post about the world of inpatient psychiatric hospitalization (it's not what you think it is). And, of course, any of y'all in the comments also have bipolar (and are willing to share)?
All images are clipart, modified by myself.