Today I am writing a letter to those who were hurt in the aftermath of my latest mood swing and its accompanying actions. I am terrible at face to face confrontation, so please forgive me for writing this out. I just felt the need to get these feelings written out for all of us.
I am ill. Truly, seriously ill. There are four serious mental illnesses coexisting quite inharmoniously inside my head. On top of that, I suffer from multiple physical ailments. Those are of lesser consequence at this time, but suffice it to say that they, by no means, ease the burden of their mental cohorts. At this time, I would like to explain these four mental illnesses to you in some depth so that there may be some understanding reached. I do this with no arrogance, but simply with the hope of all of us gaining a better understanding of each other.
My first diagnosis was PTSD. Post Traumatic Stress Disorder is fairly simple to understand as we hear about it all the time in the cases of soldiers coming home from wars having seen and experienced terrible things. What most people fail to grasp, however, is that PTSD manifests in victims of trauma in general. Those who have suffered abuse, rape, been witness to death, a horrific event, etc. It affects a part of the brain known as the amygdala, which controls your fight or flight response. If you are exposed to something that reminds you of the traumatic event, your amygdala is triggered, and the fight or flight response begins. Panic ensues, anxiety attacks may kick in, there are often flashbacks, etc. Other symptoms include nightmares, lack of sleep, irritability, change in personality, resistance to personal contact, etc.
I was given the diagnosis of PTSD because of several of these symptoms. Because of the months of sexual abuse I suffered, I am easily startled, I don’t like being touched, and am prone to flashbacks. Due to witnessing my mother’s death, I often have flashbacks, nightmares, and anxiety attacks come often. This takes a nasty toll on my daily life, to be honest. Rest assured, though, that I did spend most of my on-campus college years in therapy and learned and progressed quite a bit. I am much healthier than I was even a year ago.
The second diagnosis I was given was Bipolar I Disorder, and it came just on the heels of the PTSD diagnosis. It terrified me. I cried for days. I locked myself in my bathroom, convinced I was a monster and at a loss for an identity of my own. You see, I’d been caught in a mixed episode (a form of mood swing in which you experience depression and mania at the same time, which I’ll explain later) for nearly two months. It had destroyed relationships, my grades, my self-esteem… I was suffering. However, my roommate and now very good friend Kate also suffered from Bipolar Disorder (hers being type II) and was able to help me cope. She got me into counseling and to the right doctors. She walked me through the medications and how to manage them. Because of her, Bipolar Disorder doesn’t scare me so much anymore. I mean, don’t get me wrong, it’s still a terrifying thought that I could wake up tomorrow with my mood spinning out of control, but now I know how to get help.
To explain Bipolar I, I’ll go over the different types of mood swings experienced. First off, there is depression. That is fairly simple. The thing to understand about it, though, is how dark and empty that feeling is. It is accompanied by lethargy, suicidal thoughts, weight loss or gain, inability to concentrate, loss of interest in activities, etc. Research suggests this is caused by an imbalance of serotonin (a chemical) in the brain. The second mood I’ll discuss is hypomania, which is actually quite glorious. You become hyperactive, need significantly less sleep, and your productivity goes through the roof. However, it often frightens people because your speech pattern speeds up and there is always a crash at the end.
Mania is the exaggerated form of hypomania and occurs only in Bipolar I. It is all out chaos. It is grandiose thinking and wild behavior and sometimes delusions, paranoia, or hallucinations. It is almost no sleep for days at a time and either the most intensely happy mood or intensely agitated. I once ran around in the snow in a dress, barefoot, for days and then hopped the fence into a waterpark. Tried to swim in a frozen river, climbed pine trees on campus yelling Marco Polo…My friends had to put a tracking app on my phone so they knew where I was. Clearly, I survived, but they had to be clever to keep me alive. Especially after I tried to bail out of a moving car.
The mood I most want you to understand is the mixed episode. It is what I experience most often and it is the most terrible, painful experience I can imagine. It is the clashing of mania and depression at once – a literal war of chemicals in your brain. You have all of this energy, but you’re also so terribly depressed, and your brain is moving one million miles per hour, and it’s coming up with so many ways to die because you’re so sad and miserable and everything hurts and you’re suddenly more than smart enough to think of a way to kill yourself with just a ballpoint pen in an ER waiting room. Your brain feels like it’s exploding. Tears stream down your face. You are begging your brain to shut off. You try to communicate. It comes out in a mix of whispering and screaming. You try to control it. Can’t. The pressure in your brain is tearing your skull apart.
If that disturbs you, I’m sorry. I’m just trying to be honest. It is terrible. It is what I was experiencing just a month ago when everything went wrong. When everyone was fighting. When I yelled, when I cried, when I left in the middle of the night. When I swallowed all of my lithium.
My third diagnosis was OCD (Obsessive Compulsive Disorder). This is also tied to serotonin levels in the brain. You’re incapable of letting things go, hence the compulsion to repeat things. My case is fairly mild, and I manage it with skills I learned in therapy and medication. You may not notice my habits, like pushing certain buttons three or five times. Or getting stuck on certain words, so I have to whisper them to myself until I feel satisfied. Or having to trace over particular numbers and letters (ooooh #4 I hate you) until they’re dark enough when I’m writing by hand. I’ve gotten much better at coping with these things, but they still stress me out and they are embarrassing.
The fourth diagnosis may be the most important next to Bipolar, because it is a constant battle in which I am engaged and it is one we as a family have not discussed. During my first hospitalization, I was given the diagnosis of Borderline Personality Disorder. This terrified me. I work in this field, I study these illnesses…this one, by far, is treated with the worst stigma imaginable. Why? Because it is so hard to treat. The creator of the current therapeutic treatment for it, known as DBT, compared its sufferers to third degree burn victims because they have no emotional skin. What she meant by that is they have no protection against triggers outside of themselves. Any outside influence stings so badly that anger becomes rage, sadness becomes despair, happiness is elation, and so on.
Feeling things so deeply leads to behavioral issues. Self-harm, suicidal ideation/attempts/completion, drug use, inappropriate anger, fear of abandonment, unstable self-image, trouble with interpersonal relationships, etc. It is the rollercoaster from hell, if you don’t mind me saying so. The condition responds to some mood stabilizers, but that treatment route is still young and rarely taken as the research is still small. The most utilized treatment is therapy, and it is intensive. There are not enough specialists currently available to even help every BPD patient.
The difference between Bipolar Disorder and Borderline Personality Disorder lies in the brain. Bipolar Disorder is usually genetic, and lives in the chemicals of the brain. It has to do with a physical imbalance that is treated with medication. BPD, however, has to do with life experience that has changed the pathways in the brain. It is thought the be the result of untreated PTSD or a significant disruption in childhood – such as loss, abuse, neglect, bullying, etc. The pathways in the brain (how one thinks) are virtually permanently altered, changing the way they are capable of processing their own emotions as well as other ways of thinking.
Now that you know what it is that is happening in my head, I hope it can help you understand why it is I did what I did. Why I yelled and cried and wanted to die. Why I was unkind. Why, at times, I seem like a mean or entirely different person. That is not me. Those are the symptoms of illnesses I am trying so desperately to manage. They are the result of malfunctions in a very important organ in my body.
That being said, I am very sorry for the pain it has caused you. I never intended to hurt anyone. I never do. For anything that was said, for my actions, I do apologize. My heart aches for you just as well. I want to be happy, and I want you to be happy. I know that my mental health takes a toll on everyone around me and I will not apologize for being sick, because that is not my fault, but I will apologize for its fallout because I see the pain.
My head is above water now, and I truly, sincerely hope yours is too.
All my love,