By the way, I’m Bipolar too (2)
I had a hysterectomy, ovary removal and endometrial excision surgery two and a half weeks ago. Before the procedure, my pelvic physical therapist suggested I tell the anesthesiologist that I get anxious after anesthesia. I thought this was a great idea and told the anesthesiologist; and she told me she would take care of it, and it should be smooth sailing.
I had my two-week post-op last five days ago, and my surgeon told me that the recovery nurse had nicknamed me “hurricane”. Apparently, I repeatedly asked for graham crackers and then kept knocking them off my tray, then demanding them again. Anesthesia can make patients do the craziest things. My friend JD vomits for 24 hours and cries. Some people become violent. Some become paranoid. I had another doctor tell me years ago that there is such a thing as “code white” and it means missing patients who wander off. It happens all the time, sometimes post-operative.
My surgery was outpatient, so I went home that evening. Despite the anti-anxiety precautions, the anesthesia put me into a manic state and barely slept that night. Most people just sleep for days after this procedure. Instead, I was wide awake, in no pain because of a nerve block, and I ended up on my computer, posting upcoming programs to Instagram, working on the website, going over emails I hadn’t responded to, you name it. One of my friends who is also a therapist was observing my feed and texted me to stop working and sleep.
I have a prescription to help sleep some nights (lately it had been most nights), and not knowing what else to do I just took an extra dose and called my psychiatrist. Luckily my psychiatrist is a highly renowned reproductive psychiatrist in San Diego, extremely kind, compassionate and smart.
When I spoke to her, she told me that I did the right thing by taking an extra dose, and we talked about how to manage my mental health while I am experiencing very severe hormonal changes. She also told me that next time I should tell the anesthesiologist I have bipolar disorder, that my response would likely be more than anxiety, and they would need to alter the cocktail.
Tell them I have bipolar disorder? It didn’t even occur to me to tell them that.
Why? I don’t identify with this diagnosis; and because I am stable on my medications, I don’t feel a need to tell them about it. They have my list of medications; they can see for themselves. instead, I call it what it is, Complex Developmental Trauma. The symptoms manifest as the same symptoms of bipolar 2 (“too”, see the wordplay in the title?).
Everyone with complex trauma, likely would qualify for a diagnosis of a mood disorder, due to the illness itself and the medical trauma that can go along with it. For most mental illnesses, certain symptoms cluster, and diagnoses exist to describe these clusters. This way the doctor has an idea what your predominant symptoms are, and medications that are typically used. One person may be diagnosed with ADHD, this is their symptom cluster. Another, may be diagnosed with Major Depressive Disorder
Diagnoses exist for one reason only, to help doctors understand how to treat your symptoms.
Your diagnosis does not define you.
I don’t like to use the word “disorder”, because that is not what it is.
“Symptoms” are adaptations gone awry from earlier repetitive stressors. The events are over, but the adaptations remain. My brain still maintains a hypervigilant state from years of chronic stress, and sometimes it goes into “freeze” mode, which looks like extreme depression. My nervous system can become severely dysregulated.
So, I have leaned away from clinical language, not only with myself but with my patients as well. There is so much shame and stigma accompanied with bipolar disorder. But I think this needs to be in the conversation, because most pain patients I have, have been diagnosed with something, and I want to make sure they know it is nothing to be ashamed about.
Bipolar 1, also referred to as manic depressive disorder, is characterized by the hallmark symptom of mania; This mood state is accompanied by persistently increased energy or activity levels and often leads to destructive social, occupational, or personal functioning. Impaired in this sense means it severely affects aspect of your life, and causes serious distress, such as spending sprees, sexual indiscretions, or reckless driving, and other behaviors. This is the bipolar you see portrayed in films and TV.
Bipolar 2 isn’t that interesting.
Bipolar 2 is largely severe depressive episodes with intermittent hypomanic episodes. There are some negative consequences to hypomania, but they generally do not cause severe distress in the way that bipolar 1 does.
None of my hypo-manic episodes severely affected me in that way. In Bipolar I the mania tends to be the dominant mood, and it can get severe with psychotic features as well as accompanying disorders, delusion, grandiosity and feelings of great importance to name a few. In bipolar 2, depression is the dominant mood.
Hypomania can be useful. I have learned to harness these episodes for good and how to manage the symptoms, from diet, exercise, life balance, intentional play, neurofeedback, acupuncture and seeking community as often as I can. I have learned how to notice in the moment when I am affected and try to cope as best as I can. Sometimes I am powerless to reduce the symptoms and dysregulation I experience. If I can’t get to the beach or go out to play pickleball or any of my many activities that help me cope, medication may be my only rescue. Even if I do get to those other things, medication may still be needed. Medication is a source of shame and stigma, and I hate having to tell all my medical providers some of the strong medications I must take.
And yes, before you ask, I do meditate, I do and have tried just about everything I can before I finally reluctantly agreed with my psychiatrist that I will likely be on some regime of medication for the rest of my life. This causes me distress. But without it, I simply will not be able to function. I am constantly working to keep my mood afloat. My medication regime is stable, and I experience much fewer depressive episodes, and function well.
However, this surgery increased my menopause symptoms and is kicking my ass. I don’t know how else to say it. It’s causing rapid mood changes from agitated, to elevated, to anxious, to rage to deep despair. So, while I do not identify as my disorder, I know I need to treat the symptoms. Then I must go back to scratch and figure out what I need to be doing now, what changes to my diet I need, what treatments to do, waiting until I can get back out there in the water.
Because I am not feeling well, I can’t do much yet, and while I know that this is not permanent, it is still hard. The world goes on without you, it is just the way it is. The profound feelings of loneliness are related to the hormones and the chemicals, though it is hard to understand that when I am in it. Deep feelings of emptiness and loneliness, are one of the hallmarks of complex developmental trauma.
I am writing a book called “Medical Trauma: Navigating the Healthcare System for Patients with Complex Chronic Pain”. In it, I speak to what it is like to go into an appointment and worry about the doctor telling you that your symptoms are “just” anxiety.
Of course there is anxiety. When you are sick, you are anxious, but you are a lot of other things as well. You are anxious and you are not feeling well at all. You want help, you don’t want to be a burden on your doctor. While being treated for the anxiety IS important, and therapy is highly recommended, appropriate medical treatment is necessary as well.
Most of my patients go undiagnosed with their conditions for 5-10 years. That’s 5-10 years of feeling dismissed and invalidated. In my case, it took 20 years to figure out my abdominal pain was due to endometriosis. Pain patients must become the experts of our own illnesses and hope to find providers who can see us as partners in care.
Intake forms have anxiety and depression as symptoms for you to indicate, but the forms usually don’t have an option for bipolar. I circle both anxiety and depression, but rarely disclose that I suffer from bipolar 2.
I rarely disclose it because sometimes because I honestly forget I have it, I feel fine. I am stable on my medications. My treatment regime allows helps me tolerate anxiety and depression. Technically my symptoms are “within normal limits”, or “within my window of tolerance”, if you know anything about trauma.
However, today I must accept that I am going through a sort of de-stabilization as we adjust hormones. My psychiatrist knows I don’t really consider that I have bipolar disorder. She makes it a point to mention it. Not because that is the only story of my life, but it is the cluster of symptoms I have and need treatment.
So, yes just wanted to let you know. I have bipolar 2 disorder. It is real. It does not define me, but it affects me. I understand it and can have good healthy relationships, to understand how my energy may land on another, and to enjoy a good social life when hopefully I am feeling better.
I didn’t realize I was holding this back from the public. On some level I knew, but this has really shaken me up.
I want you to know this, because maybe you have this diagnosis too, or another.
And maybe you think this is all your fault, but it is not.
Like I said, and it bears repeating, diagnoses exist simply to describe a cluster of symptoms. What triggered these symptoms is trauma, and it doesn’t have to be a big accident or war injury. Realize that your brain really found a way to protect you from “danger”, and it simply can get stuck in this space.
You are not defined by a diagnosis, but sometimes it is helpful to know that what you are experiencing is real. If you are struggling with a chronic illness, and are experiencing severe symptoms, like insomnia, or prolonged sadness, hopelessness, or worthlessness, seek support – whether it be a support group, an understanding friend or better yet, a therapist and a psychiatrist is even better. Trauma Therapy can help you cope with these very real complex chronic illnesses. Having therapy does not mean it is all in your head. Everybody needs support. You deserve it.
