9 January 2017 5:19 PM (life | better living through chemistry)
Most people don't understand how I feel. This isn't their fault; my emotions do not work in the normal way. I have Bipolar Affective Disorder I. ‘Bipolar’ is a bad name for the condition, as it suggests a straight line connecting depression and mania upon which any mood can be plotted with euthymia (the somewhat dystopian sounding psychiatric term for a normal mood state) somewhere in the middle. This is false.
Decades back, they called my condition ‘manic-depressive insanity’ and described it as a pattern of abnormal mood states comprising some mixture of the extremes of mania and depression. This is different from the general understanding of today where the two are viewed as opposites. I think of them as basis vectors that can be combined to find a mood. (One could subdivide mania and depression still further into independent components.) What we think of as ‘mania’ is simply a combination where depression's contribution is fairly small and vice versa.
When psychiatrists refer to a ‘mixed state’ they mean the most extreme combination, where depression and mania are both maxed out. This is considered a medical emergency and is, as far as I can tell, the worst thing in the world. One feels an incredible sense of wrongness and an intensity of emotional pain that dwarfs any physical suffering I've ever felt. The last time it happened to me was more than eight years ago and I still can't think of it in detail for too long without ending up in tears. By comparison, feeling like I was going to die of asphyxiation was much less traumatic. This kind of mixed state leaves me physically shaking, speaking too fast to be understood yet unable to make complete sentences (since I kept interrupting myself), and generally not functioning well. This is what finally got me to seek psychiatric treatment. That this is called ‘a mixed state’ is unfortunate, because there are mixtures that, while probably not the most wonderful thing in the world, are much less malignant.
I experience a near constant low-level (at least when it's not higher level) hypomania. (This worries my treatment providers who have commented on it, but since it's stable they haven't tried to do anything about it.) This is likely from the effects of light on mood state (intensely bright light is known to precipitate mania in people predisposed to it) and the fact that, for me, there is no such thing as a non-bright light. (I can stand outside on an overcast winter solstice at the fourth hour past noon and the sun is still painfully bright.) This has some obvious upsides (ha-ha-ha); it gives me a certain baseline intellectual energy and excitement and probably contributes to my general skill at liking things. I feel as if I have a constant inner fire burning. It has one obvious downside that I've written about before: my impulse control is impaired, causing me to take up meditation.
People think that this means that I'm euphoric all the time and immune to unhappiness or depression. This is false. (I do seem to be immune to most forms of long-lived anxiety, though.) My experience of depression is brighter and sharper than what most people experience. Due to my ‘internal fire’, I seldom if ever feel the complete loss of energy, lack of interest, or lack of pleasure that so often characterizes depression.
I'm still interested in things, but I have difficulty getting started on them. If I manage to and make some progress, it often makes me feel better, at least temporarily. I feel an intense sadness combined with an intense longing for something I can't name. I might be quite lonely, while also withdrawing from places I normally find companionship. This isn't because I don't enjoy people, but because I find my normal euphoria turning to irritability, and minor annoyances are much more likely to make me feel sour, like there's too much fuss to deal with, and make me want to withdraw. (Also I have enough sense to know that being around me when I'm feeling particularly irritable is not a fun time.)
Having the ‘inner fire’ is still pretty useful during depression, since it gives me the motivation to keep moving forward. I think that makes it harder for this kind of state to become self-reinforcing compared to the normal depression in most people. There still seems to be a longer term effect; I can get excited and interested in something and really enjoy myself even be properly euphoric but slide back down into unhappiness again fairly quickly, so there is definitely some sort of longer-term potential that holds on, and even in the smaller ‘up’ cycles within a longer term depression, there's a larger potential for irritability. I have also noticed a repeating depressive pattern that sometimes holds of more depressed mood in the mornings that move toward more euphoric or agitated moods at night. This doesn't mean I'm always depressive or that this is my life all the time, it's just one kind of affective state I experience.
So, why am I telling you this? Because it's nice to be understood, even by total strangers. The world is a large place with a huge range of differing experience and recording more of them is worthwhile. More usefully, consider it my own little contribution to destroying the stigma of mental illness.