I have written at length, publicly, about my experience of bipolar II depression elsewhere, and as I seem now to be emerging from my latest bout (thanks, probably, to the antipsychotic drug sulpiride), it’s a good time to capture a few thoughts (including those on psychiatrists and psychiatric drugs) before the full horror of this most recent episode recedes. For bipolar depression is so awful that it’s difficult to remember when well exactly how horrible the experience is, even for one who, like myself, has experienced it many times.
For the past six weeks, I have been locked into a state of absolute misery and despair. At times, this sensation is so tangible, it’s almost physical. Of course, bipolar depression is physical. Much of the time, just being conscious is painful: I feel I want to crawl out of my skin; my brain at times feels like it wants to wriggle its way out of my skull to escape the pain of being there. By pain, I mean psychic pain so tangible it’s almost physical. The world seems utterly bleak and meaningless. My body often aches. I am terribly slowed down and very easily fatigued. The presence of other people causes me great discomfort. I speak in a whisper. My appetite is diminished. Doing the simplest things is an immense effort. I have no concentration – it would have been well nigh impossible to write these two paragraphs until a few days ago. I shuffle around like an old man, weighed down by my own psyche. I can see no hope for my life at all. It is incredible hard to make even simple decisions.
I have frequent thoughts of suicide. Why I have never acted on them, I do not know – perhaps a combination of at least knowing what is happening to me, and worrying about the effect of my suicide on others. At times, anxiety rises in me like a great physical column of dread and barely suppressed panic. I feel immense guilt. I feel like a fraud, wondering whether I am really ill or just weirdly acting out, even though it’s very clear when this state begins to lift that it has been all too real and tangible. (I find it enormously distressing to think of those out there who do not understand that the distress they are feeling may be one or another flavour of clinical depression – who may be suffering terribly with the symptoms I am describing, yet having no idea that they are ill, imagining that it is all some terrible personal failing.)
Unless I have assistance, my ability to take care of myself is greatly reduced: I eat sporadically, my sleep patterns break down, I go days without bathing, my kitchen descends into squalor; even going to the toilet can be too much effort. It may be my imagination, but physical things around me seem to break down more often. Some people seem to smell weakness and bully me in ways I would likely never attract when strong.
I am fortunate in some ways. I have lived with this illness long enough to know fairly well when I am ill and when I am not. I recognise the intense irritation and rage that at times arises, and no longer take it out on those around me. But this knowledge is slowly and painfully gained. Even though I have been experiencing aspects of this illness since I was a child, it’s only in the last couple of years that I’ve realised the extent to which I am prone to low-level depression even when ‘well’, the effect of which is to wreck my concentration and make working incredibly difficult. So for years I have battled most of the time to work, feeling intensely inadequate and guilty, while my professional life as a journalist and editor has limped along, battered and crippled, my finances a wreck, my personal life suffering setback after setback. I have been forced to work as a freelancer because the stress of trying to work full-time, of trying to pretend that I am coping when my concentration is no more focused than a swarm of escaping gnats, becomes intolerable. It remains to be seen whether this battle is yet over.
Sometimes the acute depression is so physical that it feels almost like being attacked by invisible forces, and the ancient notions of demons and devils and possession seem far less implausible than they do in the complacent light of normal secular Western consciousness. Six weeks ago it arrived like a wave hitting me, bowling me over. It wasn’t caused by stress, or unhappiness, or any particular event at all – it came out of nowhere, as it does regularly for me, every six or seven months. The depth of the troughs in this terrible cycle may vary, but the cycle itself will not – unless, perhaps, the new combination of mood stabilisers (lithium and lamotrigine, with the sulpiride) that I am now taking proves to work. Once I’m in this state, outside events can indeed worsen it, they add enormously to the stresses I’m experiencing – they circle endlessly and obsessively in my head, like a screaming velodrome of distress – but they’re not the cause. When I’m in the good part of my bipolar mood cycle, I can deal easily with the same stresses that are completely unmanageable when I’m ill.
Tell most people that you’ve been depressed and they think you’ve been feeling ‘a bit gloomy’ for a while. Well, no, there’s a bit more to it than that. Hopefully this description has made that clear.
Please bear in mind that this is my particular flavour of bipolar, and I am not suggesting that my experience is universal.