This past week I had a Hypomanic episode, it was the worst one I'd had in about two years. I kept it quiet, not because I mind discussing my mental health, but because episodes are very anxiety inducing. Getting through an episode successfully requires all my effort and the use of a slew of skills I've had to learn and develop over the years. The major goal though is to reduce and/or remove things which invoke excitement or anxiety and to (through mindfulness techniques) avoid rumination and obsession.
Now that I've gotten the sleep I need and am officially in the recovery stage I'd like to talk about some things. Key among those is the need for patients to be leaders in their own treatment with friends, family, and health care workers being partners and not commanders; and the role language plays in navigating treatment, and mental health in general; as well as why awareness and accessibility is crucial to all of these and what that looks like.
I'd like to share a favorite quote to get this rolling, because it is greatly related to what I wish to discuss.
"The Map is not the terrain."
A map is useful but it's not an identical replica of the thing it represents, in fact it would lose it's usefulness if it were. An important lesson we can glean from the saying is this: if the bridge is out, but the map doesn't tell you the bridge is out, that does not change the facts on the ground. If the map doesn't show a pack of wolves it doesn't mean there isn't a pack of wolves it just means the map doesn't show a pack of wolves.
In regards to mental health people are their own terrain in many ways. This presents a problem because we need to interact with each other's terrains, fortunately because we are a social species we have evolved communicative skills. A lot of the time people are able to draw up their own maps and share them with each other as they see fit so they can coordinate. One of the primary ways we draw these maps is through the use of language and categorization.
If however the tools don't exist or we are unaware of their existence or cannot access them to describe (or map), it presents us and those around us with serious problems. We might not be able to understand what's happening to us or those we love, let alone be able to communicate with each other. We may not even be able to realize there is a problem. Needless to say all of this can be very stressful and scary for both those with the diagnosis and others around them.
It certainly was for me and before I begin this next part, I want to be clear about something upfront. None of what I'm about to share is meant to blame, attack, or even excuse people in the health industry or the mental health industry, nor is it an attack on anyone else, with a few explicit exceptions which will become clear. Psychology and the health industry in general are constantly changing fields, it is impossible for anyone to keep up with, especially people who work as hard and as long as these people. Furthermore I am nothing but grateful that I live in a time where the field of mental health is as advanced as it is, and there are as many resources available to me as there are. What I wrote here is my raw memories and emotions and while I'm doing this to make a point I feel its important to make this disclaimer right from the get go. With that out of the way allow me now to get a little personal.
When I was first diagnosed with Bipolar type II almost 7 years ago it was difficult for me to find readily available information on my diagnosis. So much of what I remember finding online had to do with Bipolar type I. I had particular difficulty finding resources that addressed hypomania.
Not being able to easily find the resources necessary to understand my diagnosis was incredibly frustrating and made coordinating the treatment of my bipolar more difficult than I think it needed to be. Without the language and the ability to find that language it was difficult for me to get a grasp on things and negotiate with the healthcare workers who were tasked with helping me treat my bipolar.
Essentially I lacked the maps, the tools, and the knowledge of how to use both of those things, in order to make the maps I would have needed to become a leader in my own treatment.
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| Hellblade: Senua's Sacrifice is a great game about navigating the difficult terrain of Mental Health. The main character suffers from psychosis. It is a truly brilliant game and I cannot recommend it enough. |
On top of all that, I was also somewhat resistant to the diagnosis. I was annoyed at all the concern people had over me, I felt like they were treating me like a child. furthermore I hated lithium, (incidentally Evanescense song took on a whole new meaning for me), I felt like someone had taken a scalpel and sliced my soul off my body. I didn't feel like my psychiatrists were listening to me (and I was right, I know because I have a wonderful psychiatrist now who treats me like a person). I felt totally misunderstood and alone, but I also couldn't deny my episode and when I began talking to people I began to realize how different my conscious experiences were from other people.
This did little to soothe me. In fact it made me even angrier, I felt like people were trying to cut the pieces of me they didn't like out so I could fit nice and neatly into their little world. The message seemed clear to me "it's not ok to be different." which is a message I had felt a great deal even before this.
I had been resistant to the idea of taking medication since I quit my ADHD meds not long after high school. Which by that point had only been a few years. I'd quit my meds because I'd discovered they were responsible for creating a great deal of anxiety and had even led to panic attacks. (With the hindsight of my bipolar diagnosis, my sensitivity to ADHD meds makes a great deal of sense.)
Because I had never received psychological appointments for my ADHD meds none of this was known until way late. My relationship to my ADHD medication throughout my life is complex, I've both loved and hated it for different reasons at different times. As an example when I thought it was my idea it was great, when I was forced to take it at summer camp however I was pretty incensed even if I did not show the extent of my anger at the time.
And now here I was again, being told what to do while it felt like no one, with the exception of my therapist (who was not coordinating with my psychiatrist) was listening to me or taking my concerns seriously.
"Just take the pills and report any side effects, it might take some adjustments, and we'll need to do labs."
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| Sometimes the way the characters in Brave New World try to pressure other characters into taking soma to deal with their problems can feel very similar to navigating the mental health industry. |
That's what my concerns essentially amounted to. In the meantime my boss gave me a lecture about the need to call, and how they are running a business and they need to know people are going to be there. Nevermind that I couldn't call, because they take your phone when you're hospitalized. Nevermind that I didn't want to be hospitalized you fat avaricious ugly fuck faced definitely a #metoo fucking creeper! (Btw seriously fuck that guy, he can have a bad encounter with a combine harvester for all I care.)
Through all of this I felt so unbelievably alone and so angry, and really deep down broken and sad.
The point is many of the people who were tasked with helping me mistook my life for a map; and not even a detailed map. Bipolar "disorder" might as well have been my name. You may notice throughout this article, I have avoided the word disorder; this is because I believe the word has negative connotations, and is too reductionist: it attempts to narrow the diagnosis down in a nice neat way that I don't believe is really true or helpful, which leads to poor treatment and unnecessary stigma. After all if I say I have bipolar people can figure out what I'm talking about without adding the word disorder.
I am not my diagnosis, but my diagnosis is a part of me. Which is what people seemed to get backwards. The map is not the terrain basically.
So few of the people, who were at the time tasked with helping me, gave me the language or resources to understand myself. I doubt many of them knew it themselves. Few of them pointed me in the direction of places or people where I could gain that understanding or the tools needed to empower myself. It was all about what they're maps had to say, but maps are only useful if they're an accurate representation of the terrain. When you try to argue with someone whose in the terrain by insisting what's on your map is correct, you're often times not being very helpful; and while you may be a cartographer and you may know a great deal, you may even be right sometimes, it is important to listen to the people on the ground to see if you are mapping the terrain correctly.
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| I think mental health when managed properly looks something like a Heads-Up-Display (HUD) in a video game. The stuff on the side is there to aid you in your navigation. |
Because of the poor treatment I received, I ditched my meds as soon as I could, stopped seeing my psychiatrist, and went back to life as usual. Which wasn't good, I was still untreated.
From my perspective though at least I felt like I had more control of my life. Yeah sure I still had to self medicate through binge drinking and chain smoking and I still had poor diet and bad sleep hygiene, -all things which affected my diagnosis, all things that if addressed could be alternatives to excessive medication, and all things which no one told me minus the drinking.- and yes I would still have to deal with Hypomanic and mixed episodes that would occasionally come in and throw my life into one seemingly endless catastrophe of pain and elation stacked right on top of each other, but that was better than being told what to do, and being ignored and disregarded when I tried to talk about my life and how their treatment was affecting me.
Ostensibly and perhaps tragically, some of these people who I felt were treating me like crap, they were the good ones in a lot of ways. Because they were, even if very imperfectly, still trying to help, and at least now I had a diagnosis. I had a few new words and a few new tools to navigate and map.
I had the words bipolar and mania and Hypomania. This gave me a launching off point, but as I said before finding the information online was difficult as well. So much of what existed didn't describe me in the slightest, and since my psychiatrists didn't really try to discuss what my diagnosis actually meant for me I was at a disadvantage when it came to knowing what I should look for and do.
Despite having these scant new words that I didn't understand, I still had to interact and communicate with the rest of the world on top of everything else.
But so many people don't know what bipolar is, they have this distorted pop culture image that is just so wrong. It's not even in the same ballpark, I've seen so few pieces of pop-culture get bipolar even close to right.
As a result of this and other factors, my diagnosis was a set of shackles in the broader world.
I don't know how many times I encountered the: "It's all in your head." Mentality.
I do however, remember the first time I encountered it. It was, as I alluded to above, that fat ugly, definitely a sexual predator, boss of mine, who thought it was his place to lecture me. I also encountered it with a professor back in college, and I've encountered it a number of times from people in the older generations.
I can't tell you how much I hate this style of thinking. It's the equivalent of kicking people while they're down, it's shameful, degrading, and wrong.
First of all it's not anyone's place to tell people what their mental health is or isn't, unless they're specifically tasked with that job, and they have the necessary skills to do that job; and even then as often as not it's mostly the job to communicate and find out about problems, so those problems can be addressed. A lot of the time what it means to take care of mental health is to listen very critically and very carefully so things can get solved through good communication. Bulldozing in with your own ideas may have its place, but you have to really have rapport and know what you're doing and even then things can go wrong.
And considering my poor experiences even with people who supposedly have the right qualifications, I'm gonna say unless what someone has to say is coming from a good place and isn't some uninformed bullshit, Joe Blow the history professor and Sally Jones the retail specialist need to learn to keep their tongues in check until they can learn and listen.
But with that out of the way I do want to say something about how dumb the "it's all in your head" shtick is. First of all no. That is wrong.
Second of all the head is kind of an important place… it literally controls everything. Do the people that make this argument realize how bad of an argument it is? Like yeah, I'm not complaining about my pinky finger Alex! That would be much more straightforward.
Anyway the sentiment behind this line of thinking is, you should just have control. Which ya know, yeah! no shit sherlock? That's kind of the problem.
The reason this is wrong is because it ignores everything we know. It's literally a statement made from ignorance with unironic pride. There are mountains of evidence regarding research into the neurology, genetics, and endocrinology of bipolar as well as its psychological basis. If you think otherwise all I can tell you is you're wrong and your pride at being wrong is disgraceful.
But let me clear this up for some of the knuckle draggers in back. No it isn't in my head. This past episode alone I lost nearly 10 pounds without significant alterations to my diet or exercise. My episodes radiate through my entire body, it changes everything, including the way my body processes stimuli. My appetite becomes either so voracious that I am always hungry or I don't feel the need to eat at all. It alters the entire way I perceive and interact with the world. You know how when you're angry you might shake or your heart races, you've felt the urge to hit something as a result, how anger moves through you? Imagine not being able to regulate something like that, imagine that instinct popping up for what amounts to no good reason and continuing to pop up incessantly and inappropriately. Imagine being possessed by the spirits of your emotions like you're some puppet for days on end with little to no sleep, not being able to turn it off and still being expected to function like normal. It requires so much to control myself in an episode and you are so lucky you will never know what it is like, so count your blessings.
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| What a severe Hypomanic or mixed episode feels like visualized. |
So this line of thinking is wrong on the most basic level; It isn't "just in my head", no it isn't one hundred percent under my control, and yes it is still my responsibility regardless of whether it is or is not my fault (protip it's not my fault).
By the way the bit about responsibility? That's what people who say things like this are really concerned with. They don't like the idea of people using their mental health as an excuse to shirk their responsibilities. After all they have it rough too, and no one gives them a pass.
I wish I could say people didn't abuse the good trust of their mental health diagnoses to shirk responsibility and gain privileges, but I don't believe that's true. Also I'm sorry to those people that don't feel like anyone is giving them a pass for anything. Maybe they should fight for themselves, stand up with others and get what they deserve, while exercising some compassion instead of tearing others down? Ya know solidarity it's just a thought...
Point is they are not entirely wrong. Loving or even just knowing someone who lives with a particular diagnosis doesn't mean allowing that person to get away with whatever they want. It means being understanding and working with them to ensure they remain responsible, and using language which is either neutral and useful or outright empowering over language which is degrading and harmful.
One great example of this was an encounter I had with my current boss (not to be confused with swine boy). She knows me very well and we have a good manager/assistant manager relationship. I waited until 3 days into an episode to tell her. I had my reasons and I thought they were good, but she asked why I didn't tell her sooner. She said it would help if I told her as soon as I knew that way she could prepare her expectations for my performance. Since she knows what I'm capable of normally she holds me to those standards, but if I'm really struggling it allows her to readjust her standards. There wasn't a moment of doubt that my mental diagnosis was fake, or that I was using it as an excuse. The language used was totally neutral and my boss was genuinely concerned and curious about what was going on with me.
All that I've said here I say not to complain, but to empower. Things have gotten better in the last seven years both for me and just in general in regards to mental health. Things obviously aren't perfect, but they're getting better, and this is where I'd like to address awareness, accessibility, and representation and what they look like to me.
At any given time there are so many things in both our external environments and in our minds competing for our attention. Learning how to prioritize and recognize what's important, when and how and why, is a daunting task and it is the reason we institute education and training programs. So that in the moment we can have an instinctual knowledge at our disposal which helps us in the process of awareness and prioritization.
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| Dora the Explorer over here! |
Mental health as it is currently understood is a relatively new phenomenon, and one that deserves more investment from our society as a whole. In particular, mental health needs to be taught from a far younger age, so that people as they mature into adolescence and adulthood can identify and sort out the nuances of their own health and learn to grapple with the unique obstacles they are likely to face as an analysis of who they are.
Better education can and will lead to more fulfilling lives with greater opportunities for success, for both the individual and society as a whole.
Much of what I learned about mental health I either learned through pop-culture stereotypes that as oft as not did more harm than good, through rudimentary psychology classes taught late in high school or college, or through my own research and clunky encounters as a result of my diagnosis or the diagnosis of different friends.
Psychology is a broad field so I don't expect that I or anyone else ever could know everything they would like to know right up front, but I don't believe that our society even equips us with the basics.
I think time devoted in junior high, or maybe even a little earlier, to studying some of the common issues people are likely to encounter like depression, anxiety, substance abuse, etc. would go a long way to improving the quality of life for most everyone; and I mean really devoting some time to those studies including the more subtle complexities of those common mental health struggles.
As an example I don't think of myself as an anxious person, mostly because I don't fit many of the stereotypes, and indeed I am not very anxious in a lot of ways that other people are, but I still encounter anxiety especially in my manic states. As a result of poor education it took me a very long time to identify when I am feeling anxiety within myself, when it is healthy, and how to manage it. Understanding anxiety in more depth would not only have greatly helped me in certain instances but it would have helped me understand others better.
There are similar blind spots in depression and other mental diagnoses that we as a society are oblivious too. Better and earlier education can and will help us close the gaps on those blind spots, which will aid us in addressing our problems.
Awareness though will not help if there is no accessibility. There are two aspects of accessibility, the first is our medical system, which is incredibly complex and as a result is difficult to say what the best path forward is, furthermore I have very little control over that aspect on my own individual level. What is clear is the current system is broken and cannot remain unaltered, what alteration must occur is a matter of political policy and aside from saying I am more left leaning on the topic I will leave that aspect alone. The second aspect of accessibility is one I'm happy to say has been greatly advanced in recent years, that aspect is the aspect of educational resources and material.
Even in between the time of my diagnosis and now there has been an explosion of content online regarding these subjects. Tools like being able to read from, hear, and see what people who are in similar situations have to say and think, and what their experiences are like. I know I've found youtube videos, subreddits, Facebook groups etc. etc. that have helped me feel like someone else gets it. Memes especially! Always the memes! Also it turns out many others with bipolar have difficulty differentiating between Mania and Hypomania too, so some of the peculiarities of my case aren't all that uncommon.
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| A meme of my own making. I'm a nerd sue me! |
There's also been a lot more added in just the raw information. Healthline, psychology today, even updated wikipedia articles and much, much more are being dumped online daily; and thanks to the wonderful accessible nature of the internet, now more than ever, the latest scientific data is more readily available to the people who need it, which in turn can help to empower people to become the leaders in their own mental health. Additionally it helps patients and doctors alike stay up to date.
One of the most solid pieces of advice I can give is use Google liberally. Try as many different variations as it takes, there is likely some information out there which can help you. At least that has been my experience.
Another piece of awareness and accessibility is having the ability to share your experiences if you desire. It is my belief that doing so destigmatizes the sense of embarrassment around mental health and can inform and correct any faulty knowledge those without a particular diagnosis might have, as well as helping those with said diagnosis. It is in that vain that I have written this and is why I will now discuss what has helped me on my own journey.
First and foremost standing up for myself, demanding the respect of being treated like a person, and just generally being resolute in knowing who I am was invaluable in getting the treatment I needed, even if it was at times frustrating and difficult.
Second, I think often when we think of mental health we think in clinical terms. That was certainly my experience, however throughout this post I've used strong language, expletives, spiritual metaphors, and insults to name a few of my tricks, that was not by accident.
Sometimes you need scientific language, but just as important is the need for the more primal language of expression, which has its own grace about it. The two languages together working in tandem are the ideal. For example I needed the diagnosis for any of this to be helpful and to even know who I was on some level, just as I needed art, music, and everyday speech to help make it real and strip away the stigma so I could see the whole picture more clearly. Mental health is a deeply personal journey and ultimately the language we choose to use is just as personal. Our terrains, while sharing many commonalities, are each unique; ideal mapping will take this into account and in turn lead to personalised maps that accurately define the terrain and in turn facilitate better navigation (or treatment as it were).
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| I don't know how accurate or inaccurate the left-right brain analogy is as I am not a neurologist, but I like this image and it highlights I think the importance of the whole picture and maintaining balance. |
Which leads me to my next piece: the importance of art in my life as well as its usefulness with regards to making maps, both the art I attempt to make and the art I enjoy and contemplate. I am not a musician, I can't tell you crap about the technicals of music, but I know when it speaks to me; and I know when the lyrics hit me on a perfect level. This song in particular is good (https://youtu.be/0auFZ5OVjAk) I also know when a song sucks, there is a special place in hell for the song Manic Monday.
As for film an TV I'd like to see more and better representation, and I have seen more of that over time, even if not as much or as often as I'd like. That said I have seen some things which can be interpreted pretty compellingly to represent certain themes regarding mental health. I've already discussed Annihilation in a previous post (the books were just as good fyi), beyond that though one of my favorite tropes is the super-powerful badass who's incredibly repressed and must be watched out for. The types whose powers seem ready to explode out of them at any moment and just devastate things. That unpredictability and unbelievable power, always in constant danger of being unleashed feels very relatable to the way I feel about manic swings. Vanya from Umbrella Academy is a good example, as is the Hulk and many others.
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Vanya ending the world like a BAMF |
Beyond that I have also used my writing as a means of therapy and expression to deal with many complex and difficult issues I encounter in my mental health journey, including this post.
The psychiatrist I have now really understands a lot of this. If I say something about a resource I know of, or a technique I use, or a piece of art I like he'll take a note: not just for me but also so he can help or share it with other clients. He listens and he cares.
He understands mental health is not contained to something neat and tidy, it's our lives, and as much as I've talked in terms of mental health I could just as well have said health. This is because as much as we try to draw a distinction the two are intimately connected. A holistic approach to mental health has been a great strategy for improving my life, and I can not understate the importance mindfulness has played in all of this. Which he has always been a big believer in and has encouraged me to follow. Reducing drinking, quitting smoking, adopting a better diet, and regularly exercising has improved all aspects of my health including mental and otherwise.
Furthermore as a result of this good rapport I am for the first time in a long time on the kinds of medication I need to live my best life. Medications for both my bipolar and my ADHD.
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| Medication when done right is kinda like potions in a video game they're there to help. |
Which leads me to my next point. I no longer tolerate toxic shit in my life if I can help it, and if I'm stuck in a shitty situation I try to find ways to extricate myself from that shittiness. Which includes people, places, or situations and events. My life is too short to be spent being miserable with other things and people that make me feel miserable for no good reason.
Consequently I have found the people that care, and I'm always learning what I can do to try and take care of myself and my loved ones while learning how to communicate effectively and maintain good relationships.
And finally I've taken the lead on my own mental health through all of these processes. I'm very good at describing and understanding what's happening to me now. I have the language and the skills necessary to get what I need and stand up for myself when needed. I was persistent at finding the help I needed and just as importantly I had people, like my loving wife, my family, and my friends fighting alongside me and encouraging me the entire way, even when they didn't understand or I was being a pain.
Thanks to all of these things I was able to for the first time in my life successfully manage a hypomanic episode with minimal damage to the other aspects of my life. I cannot verbalize how proud of myself an accomplishment like this makes me feel.
Wowza! This got a lot longer than I'd originally expected, but I really couldn't condense it much more than it is, believe me I tried. If you've made it this far thank you so much -you're a bloody saint- now let's see if I can wrap this up and let you get back to your day.
Writing this has been very cathartic and helpful to me and the people I love. I am so happy to be where I am today, but it has been one hell of a journey. If you are struggling I really hope you can find what you need. Furthermore I hope my screed here can help you find something useful and/or relatable that helps you on your own journey. At the end of the day I am an optimist and I do believe we can all make things better, especially when we are given the tools and understanding necessary to succeed.
Cheers!
