Bunnies

I was sitting at work the other day when I received a mildly humorous email about my blog. I chuckled. A coworker, who is likely to turn into a friend, inquired about the source of my perceived pleasure. I told him that my sister wrote me a witty comment about my blog, and he responded by saying that I should monetize my blog using Google AdWords.


In a perfect world, I would have said, well, I would, but I'm worried that all the ads will be for medications because the blog is about mental health. If he was interested in the content of the blog, he would have asked more questions and made more comments, and if not, well, maybe someday he'd meet someone who is and pass it on. Msybe he reads my blog already and would have said a nice thing or two. But I was afraid, so I didn't discuss the ocntent of my blog. I didn't use this perfect opportunity to share something I'm proud of. Instead I laughed, my defensive laugh, and said, "well, I don't know. It's not like my blog is about bunnies."

This peron might know what my blog is about. I haven't made the blog a secret; I've shared it with individuals and on my Facebook page. I have already chosen to make this blog public, so why skirt around an issue, too polite and uncomfortable to address the elephant in the room? I don't know, but I think that's how a lot of conversations about mental health go.

Decisions

I am not good at making decisions. I am an endless loop; I will create circular logic patterns and ride them like genuinely terrifying roller coasters.

Now that I've learned, after an ongoing period of careful observation that I'm exceedingly proud of, to identify my moods, my confidence in my own decision making has unfortunately decreased. My depressed self doesn't feel confident making a decision on her own, without my "normal" self and my hypomanic self. My "normal" self tends to be paralyzed by indecision and wait for either my depressed or hypomanic self to come out and play. My hypomanic self wants to make every decision possible, act on it, and plan my life six or twelve or eighteen months out. I am an endless loop.

Coming Out

All week, I've kept a list of potential blog posts on my cell phone. I've gotten really excited thinking about my new project, and I have scribbled notes about the man I saw at San Francisco General today, the article about a "trend" of bipolar celebrities these days, the difficulty I have making decisions. There is so much to say about this illness, about the humor, the sadness, the small moments of triumph and despair that this albatross brings as it swings inexorably around your neck.

Then I read this blog post. The post explains how important anonymity is for someone blogging about his or her mental illness, and how a failure to protect your identity can adversely affect your work life and your personal relationships. Just like bipolar disorder. She compares mental illness to minority sexual orientation, but says the stigma is currently worse for the mentally ill in most situations.

This is something I've thought a lot about. There is heavy stuff to write about here: heavy feelings, heavy experiences, heavy stories. But sharing it lightens the load, because I know that if I had found a resource like this when I was first learning about living with this disease, it would have made my life very different. I remember the few times I've met someone with this diagnosis and how relieved I felt: not happy, not joyful, just relieved. Relief is such a sweet thing sometimes. My memory fhat feeling makes me want to share this blog with everyone I know, in case they know someone who might feel that way when they read it. Or maybe that's not why - maybe it's because I want to break the silence and because I need to share, because writing is what I do when I feel scared and alone and because writing is the only thing I can do that makes me feel like I can leave something in this world, something real and maybe even beautiful.

On the other hand, it's scary. Coming out is scary. People are ignorant, and these things are personal and hard. Do I want my coworkers to see this? My boss? A guy who might be thinking about asking me out? Why is it that it is less scary, and more liberating, to share this blog with strangers than with those closest to me?

These questions scare me. They make my tummy hurt and they leave me with a sense of loss, as though if I shut this down, if I don't share this blog, I'm losing something. Because I'm passionate about this blog, and this topic, and anyone and anything out there help me this illness. But that doesn't mean sharing is the right thing to do. Or does it?

There is no reason to suffer silently

As I previously discussed, Catherine Zeta Jones recenty sought treatment for her bipolar II disorder. This might be one People magazine that I actually buy outside of an airport. Excerpt:

"This is a disorder that affects millions of people and I am one of them...If my revelation of having bipolar II has encouraged one person to seek help, then it is worth it. There is no need to suffer silently and there is no shame in seeking help."

This is particularly important because the faces of bipolar disorder painted by the media are after particularly frightening, and because there is a lot of speculation about celebrities that *might* be bipolar; for example, Charlie Sheen, who fundraised for a Canadian bipolar awareness organization despite denying that he is bipolar. Ms. Zeta Jones proves that you can be bipolar AND your own advocate, bipolar AND beautiful, bipolar AND successful, bipolar AND eloquent. Thank you.

Physical Symptoms: Catch-22

Since I was diagnosed, I've learned about a variety of physical symptoms that accompany my mental ones. Each time I experience one, I have to admit that I feel a tiny bit of relief. I'm a little relieved that I have evidence (as though my experiences aren't evidence enough) of my condition. I don't think those with mental illnesses are alone in feeling like this: I'm sure sufferers of migraines or other chronic illnesses sometimes feel frustrated that they "look just fine" even though their world is collapsing around them.

That being said, here are a few physical symptoms of depression that I find particularly interesting. Albert Einstein said that if you cannot explain something simply, you do not understand it well enough; let it be very clear that the fact that I can explain some of these things briefly do not mean I understand them well.

Suicide and Economic Downturns

Mental illness, behavioral economics, and the New York Times are all fascinating topics to me. So when the NYT ran this article, which shows evidence that suicide rates are correlated with business cycles. Excerpt from the article:

"To investigate the effect of business cycles, the researchers calculated the average rate during periods when the economy contracted and compared it with the average during the years leading to downturns. The sharpest increase occurred at the start of the Great Depression, when rates jumped 23 percent — to 22.1 in 1932, from 18.0 in 1928. The study found smaller bumps during the oil crisis of the early 1970s and the double-dip recession of the early 1980s, among other economic troughs.

The suicide rate generally fell during periods of economic expansion, with some exceptions. Rates among people in their 30s and 40s went up during the booming 1960s and actually decreased among the elderly in the severe recession of the mid-1970s.

Cultural factors played a role, the authors argue. “The social unrest and tumult of the 1960s may have added to young people’s mental stress and therefore contributed to their continually rising suicide rates,” they wrote. “For the elderly groups, the rapid increase in Social Security benefits in the late 1960s may have provided a safety net in hard times.”"

The Secret

One of the scariest things about mental illness is that it's a Big Secret. People tend to discuss mental illness when it manifests itself in paricularly scary ways: homeless people chasing you on the San Francisco sidewalk, successful, highly functional grown ups taking their lives when the pain is too great. The day to day side of the mental illness, the humors, the small tragedies, the ironies, are Big Secrets (and also, what I hope to capture in this blog).

Last week, something happened to expose my Big Secret at work.

Thanks to my celebrity gossip addiction, I just learned that Catherine Zeta Jones briefly checked herself into a mental health care facility to treat her bipolar II disorder. I also learned that bipolar II disorder affects 6M Americans, or translates to a lifetime prevalence of 0.5-1% (thank you Wikipedia). First, I think that it is incredibly brave of Zeta-Jones and her family to publicly explain her need for treatment - an article like this can do more to demystify and destigmatize mental illness than countless studies, academic articles, et cetera. Catherine Zeta Jones is beautiful, poised, talented, successful... and bipolar? Stick that in your pipe. Secondly, any time someone seeks treatment voluntarily, they display courage and emotional integrity beyond words. Second, I was inspired by Zeta-Jones to evaluate my own need for some "treatment". When you have ample amounts of money and it's close confidante, time, you have the luxury of stopping your life, at a moment's notice, to take a break from reality (Charlie Sheen), become a fairly routine criminal (Lindsay Lohan), or take care of yourself. As a normal person, I don't get to shut my life down when I feel that my symptoms are getting the best of me, but it's no less important to recognize when my life needs to come second to a little break. This week was the third in a row that I felt I was running on empty and my symptoms were catching up, so I did something new and scary to me: I shut down the "non-critical" elements of my life. I focused on sleeping, working, and taking basic care of myself, and I spent the rest of my time doing nothing. And boy, did I need it. Maybe I have something in common with Catherine Zeta Jones... (other than our devasting good looks).

Upside

Is there an upside to mental illness? This question stems from one that I asked my doctor a few months ago. I asked, "Don't you think that if I could be Anushka, but not be bipolar," I would be an infinitely better person? He smiled benevolently and rejected the hypothesis. If I weren't bipolar, he said, I couldn't be Anushka. When you have the flu, it's quite obvious that you want, need to get better. If you have cancer, it's quite clear you'd rather not have the cancer, and those these illnesses change you, define you, they are not literally part of your brain chemistry. When I had a serious physical illness a few years ago, it changed me, the way that I look at the world, but it was not part of my core identity. With mental illness, it's hard to piece those things apart: Am I "naturally" (sans illness) an enthusiastic person? How enthusiastic am I? Am I social? Impulsive? Sexy? Would I "naturally" have periods of extreme introspection and melancholy? Many do! But how often would I have mine? What would they look like? It's nearly impossible to piece my identity as a bipolar patient away from my identity as a human, just as it's frustratingly difficult to piece symptoms from "normal" twentysomething feelings and behavior. Like sexuality and athleticism, it's a spectrum, and like the latter, it's hard to tell what could and could not be accomplished without certain enhancements. Is there a reason to piece these things apart, to "know" what you'd be like? For someone as introspective as I am, there's a lot of guilt, confusion, and pain around the ways that I've acted and treated people in the past, and there's also a tremendous desire to both explain it away due to an emerging diagnosis and not allow myself to be defined by said diagnosis. So it's a line that the mind is naturally drawn to, but it's constantly shifting. So would I rather not be bipolar? I don't know, and that's a source of guilt, shame, and wonderment. Who doesn't wish their illness away, or at least, isn't sure if she does? Right - someone's whose illness is embedded within their behaviors, their personality, even their soul.

The Same Reasons, or Why I've Started this Blog

Yesterday in my chemistry class, a woman in my class shocked. She's a pharmacist, and I was telling her about my plans to write about lithium for our independent projects in class. She seemed impressed by the amount I already knew about lithium and displayed no emotion when I told her (it's important not to lie about these things, at least my "how to survive" rulebook) that I take it. She said, "it's inspirational that someone can be as successful as you are with this illness". We got to talking about mental health, and my reasons for wanting to be a psychiatrist. If it was so hard for me to make it through what I went through over the past few years, how hard must it be for those who do not have the safety network, the financial security, the physical health, the happy accidents of birth and family that I have? And so on. She listened intently. When I asked her why she wanted to be a doctor, she looked me dead in the eye and said, "The exact same reason as you." This is the second time in the past three months when, after disclosing my illness, I've found that a colleague or peer shares my diagnosis. Either I'm a magnet for bipolar people or there are more of us than it feels like as we hide our episodes from our bosses and watch our pharmacists struggle not to display any emotions (confusion, pity) when we fill our prescriptions (is this really for you?). As the woman in chemistry class pointed out, "it's because this illness isn't like cancer: you always have it and you don't get better or worse". So instead of better or worse, I'm writing this blog. I'll share some very brief short stories on the topic of mental illness, my own observations of mental diagnoses and our society, and hopefully links to other people who are writing and thinking about these things in much more thoughtful ways. Despite the somewhat upbeat tone I hope this blog will take, it's a risky effort for me. It's scary to speak so openly about these things, but that's the goal. Because for better or worse, my illness is here to stay. And so am I.