Let’s Talk

Updated June 9, 2018, following news of the death by suicide of Anthony Bourdain

If you’ve stumbled upon this note, then it’s because the algorithms or some other mysterious force in the universe brought you here. The topic isn’t going to be neat or comfortable. In fact, things might get quite jagged and painful. But if you can get through this, then I can, too. (Or should that be: If I can get through it, then so can you…?)

I have manic depression. Now many would use today’s parlance and say bipolar disorder. I prefer the phrasing in my first sentence, and let me explain why. I didn’t begin this paragraph by writing I am bipolar or even I am manic depressive. When self-disclosing about my chronic illness, my use of the verb have followed by an open noun compound is deliberate, and carefully constructed. That’s because my mental disease shouldn’t be boiled down to an all-encompassing label; it is indeed a preexisting medical condition, but not the totality of my identity. In this way, my manic depression is not dissimilar to your diabetes, your high blood pressure, your high cholesterol, and so on. And for me, the term bipolar conjures up images of an alien with two poles jutting out from her head. It also implies that mania and depression somehow cannot overlap. (I can assure you that during those times when I was traveling at the speed of light in my most manic stage, I was still deeply depressed. To understand this point better, check out Dr. Kay Redfield Jamison’s excellent memoir.)

Two decades ago, as a newly divorced individual, I was at a different point in my life. I had lost virtually everything, so I thought I had nothing more to lose. During the culminating job interview with a potential employer, I ended our congenial exchange with a question: “Oh, one more thing. I have manic depression. Would that be a problem?” Without missing a beat, he replied, “As long as you take your medication, it should be no problem.” I was hired, I did great work, and I learned a lot.

There have only been two times when I felt so alone, so hopeless amidst the confusion of the world and my place in it, I thought seriously about taking my own life. In the first instance, I was in my early twenties and trying to recover from a romantic breakup. Once it was clear that I had swallowed some pills, I had to be taken to the emergency room. Fortunately, the dose I ingested did not make a permanent impact. The second instance occurred when I was in my early thirties and living abroad with the man who was then my husband. As a new mother still suffering the effects of culture shock, I was exhausted in every possible way. One afternoon, when my husband was away at work and I found myself in the throes of postpartum free fall, I stood on the balcony of our fifth-floor apartment and pondered the distance between the railing and the ground below. I am thankful that at the pivotal moment, one sound pierced through my despair. It was the cry of our four-month-old daughter, who had just woken up from a nap and was hungry. I quite literally talked myself off the ledge so I could go inside, pick her up from her crib, hold her, and feed her. (The repetition of so many object pronouns in that previous sense is intentional, for it was my daughter’s reliance on me that somehow kickstarted my will to survive and gradually, to live.)

Today, I take 450 milligrams of extended-release lithium once a day, usually in the evening with my slew of vitamins. On rare occasion, in order to stave off one too many sleepless nights, I dip into my emergency supply of sleep medication prescribed by my doctor. I can happily say that more than twenty years after my official diagnosis, I now resort to this sort of “reset” button an average of two nights out of 365. A few years ago, my psychiatrist at the time announced his retirement from private practice. He had helped me navigate the first decade after my divorce, which was not coincidentally the most difficult period of raising my daughter. (Her father and I agreed that sole custody would be the most loving arrangement, given our circumstances at the time.) I brought Dr. W a mug and a card, on which I wrote these words: Thank you for the gift of mental health. He blushed, and with a broad smile, said I was one of his most successful patients.

But the hard-won fight for balance is never static. Indeed, my commitment to staying relentlessly focused on self-care is ingrained in my approach to life each day. It has to be. Family and close friends quickly become concerned when I am unusually exuberant, overly snappish, or inexplicably listless. Fortunately, these extremes don’t rule my life anymore.

In his brilliant TED Talk, writer Andrew Solomon explains that the opposite of depression isn’t happiness, but vitality. I can’t think of a better description.

The disease no longer terrifies me, but I do have to keep even fictitious demons at bay. Regular exercise, a healthy diet, adequate rest, time for reading and reflection, and lots of music and artistic expression sustain and modulate my creative energies. I no longer drink alcohol the way I did in college, where I once was so depressed, I retreated to my bottom bunk for three straight days. Life is good, as they say. And yet I sometimes let the past nag at me: the pre-diagnosis years and memories of being an unruly daughter, a confusing girlfriend, and later, an unhappy wife who sometimes felt caged. I still care for my ex-husband, but despite his loving and valiant attempts, during our marriage he fell woefully short of understanding what the disease was and wasn’t—and who I needed to be.

The stigma associated with mental illness can crush one’s spirit. Equally harmful, I believe, is the temptation to glamorize it. For even the most famous patients, the struggle is real. In my case, I’m no longer as brash as I was during that 1999 job interview. I am careful about which friends I confide in about my health. And of course, I sometimes worry about my employer or coworkers. Will they feel uncomfortable around me? Will they see the work that I do in a different, potentially negative, light? And what about the neighbors?

Recently, an article in my local newspaper, which you can read here, made me pause and reflect on how much I might lose if I remain silent. Or more to the point, how much others stand to gain if I speak up.