Bipolar Affective Disorder · Recovery

Well and wobbly: adjusting to stability

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From: Marbles, by Ellen Forney

Everyone made this whole bipolar thing sound easy- take your meds and you could forget about it. 800mg lithium at night, a sleeping tablet as and when, an antidepressant if you need a nudge up or quetiapine if you need reigning in a little. Easy as.

I’m finding it a lil tougher than that. Sure, getting well, getting stable has been easy enough. Meds each night, appointments with my CPN, OT, and psych when needed. Gradually building in things like exercise and pizza dates with friends, volunteering and training courses to keep me occupied but as stress and responsibility free as possible.

But no one told me once I was stable, once I was well, I’d start to struggle with other things- things that weren’t related to my mood, but that apparently come part and parcel with having bipolar disorder. I started struggling with every one of the things I’ve listed below before my last relapse, and I’m currently struggling with all of them now. Only this time, now that I’ve identified these things as the precursors to my last relapse, I’m doing what I didn’t do last time- talking about it.

SO, while stability in bipolar disorder is very much welcomed, here’s a few things I’ve found tough while adjusting to that newfound calm.

  1. The leap from unwell to well- for me, I’ve gone from standing on the roof of the hospital to back at work in maybe three weeks. Pre-diagnosis and pre-lithium, I’d only ever had a few brief stints at stability- two of which still weren’t *that* great. Bar once, those times came after months and months of struggle, and then a gradual crawling out of the hole. On lithium, I’ve stabilised and gone from really unwell, to really well, in no time at all. It feels like months or years of progress smashed into a matter of weeks- and it probably sounds a little silly, but it’s kind of a lot to process? It’s kinda hard to reconcile that both those people can be you- the acutely unwell manic or despondent depressive, and you, well and stable- and in the space of such a short time. And given that pre-lithium, stability and wellness wasn’t something I was overly familiar with, it is strange (and honestly, at times a little scary) being in a place where I am thriving, rather than surviving with my illness
  2. The calm after the storm- bipolar episodes, and particularly manic or mixed episodes, are intense. For me, mania has always been blurry, so when my mood levels out I start trying to decipher what actually happened- when it came on, how it came on, the things I said and did, adjusting to medication changes and picking up the pieces of my life that got torn to bits in the process of it all. If mania is a raging tornado passing through, stability then is the eery quiet that comes afterwards. And it’s not that it’s not nice, or welcome, or a relief…it just takes a little getting used to. Stillness after however long of chaos can be hard to wrap your head around
  3. Pathologizing- the reality of bipolar disorder is that it’s a chronic condition that requires long term and often life long treatment. It’s a dormant volcano in that sense- it can lie sleeping but there is always the chance it will erupt once again. When I first started taking lithium, I second guessed every emotion, every mood- as did those around me. If I had a few good days in a row, did that mean I was getting high again? If I had a hard time getting out of bed in the morning, did that mean depression was coming back? It took me a while to learn (with the help of my therapist) that no one is a 5 out of 10 on the mood scale every day. I was allowed to have worse days (a 4) and I was allowed to have better days (a 6)- that was ‘normal’ mood. It only becomes concerning if it starts to slide above or below the ‘normal’ fluctuations of mood. But that’s the danger. There can be a bit of a tendency to pathologize ‘normal’ mood fluctuations (like feeling shitty after a long day at work or your car breaking down), or jump to conclusions and fear the worst if you’re scared about having another episode
  4. Symptom checking- OH. MY. GOD. Leading on from the previous point, it’s enough of a pain when you start second guessing or fearing what your mood might do, but one of the big things I struggle with in stability is when the people around me symptom check. If I laugh too loud, I’m quizzed if I’m still taking my meds. When I spent the first two weeks after discharge lazing round the house, I overheard my dad, all dramatic, telling mum he just ‘knew’ I was going to be readmitted. It’s frustrating being observed and it’s hard knowing that people are just as scared as you are of things falling apart again
  5. Missing mania- I know all too well that mania isn’t actually, that great. That happy-hypo can turn into restless and agitated and irritable. That grandiose tips into delusional. That mania means no driving for months at a time, time off work, having to leave university. That labile mood and swings from high to low as you come down (pumped full of heavy duty antipsychotics of course) is no fun- unbearable, actually. So I don’t get why I miss it. I don’t understand why my brain wears rose tinted glasses when looking back at the times leading up to, or indeed, during the early parts of my admissions for mania. Rationally I know mania is a raging tornado, chaotic and draining. But there’s this little niggle that still thinks it’d be a Good Idea. I crave the good bits about it- feeling invincible and productive and buzzy and drunk on life. I was confident, uninhibited, ‘infectiously happy’ and a ‘breath of fresh air’. It’s irrational, sure- but it’s a niggle. Some days, it is very difficult to ignore that niggle
  6. Being well, but still ‘sick’- I talked about this with my OT recently- that it’s hard being in a place where you’re well, where you feel well, but know that you’re not? That, technically, you are sick. That it’s medication keeping you well, and that your symptoms could flare up at any time. Compare it to a course of antibiotics- a lot of people will stop taking them when their symptoms ease up, but the full course is needed to clear up the underlying illness. But people can’t see a need to keep taking them once their chest pain passes or their breathing returns to normal. It’s the same with bipolar. When you feel well, it’s hard to grasp that you’re not- so swallowing pills and keeping strict bedtimes and making ‘good lifestyle choices’ starts to feel unnecessary
  7. Thinking you’re well- it’s a little contradictory, given that the last two points would suggest I accept I have bipolar, but I seem to hit a certain point in ‘recovery’ and start doubting I’m ill at all. I hit a point where I think “but I’m fine now, the whole thing was obviously just a mistake, people overreacted- I wasn’t that bad!” This comes back to struggling to come to terms with the diagnosis, but can get compounded by lack of insight. When I’m well, intellectually I can accept I have the illness, but am in denial. When I start to become unwell, I am both in denial and can’t actually recognise that I’m unwell at all
  8. Medication- !!!! It! Is! So! Hard!!! If you feel well, why would keep taking medication for symptoms you’re no longer experiencing?? If you ‘miss’ mania, if you feel like medication is suppressing the ‘real’ you, feel that medication is stopping you from being as ‘happy’ as you know you can feel, why would you want to keep taking it?? If you don’t believe you have an illness, why would you take keep taking medication for it??? You wouldn’t. And it gets hard when you start believing those things, to reconcile your ‘rational’ brain with the ‘bipolar’ part

*I just want to point out that my psychiatrist has said such feelings are common/normal when new to a bipolar diagnosis, and that over time, and with acceptance, these feelings and beliefs will lessen

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