A story of doubt, trauma and truth
In June 2018 I checked myself into a psychiatric clinic for three weeks.
In many ways, the time I spent at the clinic was one of the most profoundly validating and healing experiences of my life. I was, first of all, extremely fortunate to have medical insurance which allowed me to check into a private clinic instead of a state institution; the latter being a different kettle of fish entirely. Also, I went by free choice – I’d realised I was on a downward spiral of exhaustion, cognitive decline, and suicidal ideation, and I got help.
It took some doing though – I had to convince my psychologist that I was depressed enough, who then had to find a psychiatrist willing to recommend that I be checked into a clinic, after which I was to phone my medical insurance provider with the preliminary diagnosis and recommendation and wait for them to approve my case. I spent hours on the phone. I wept in many different offices.
All the local psychiatrists seemed to be on leave, which meant that my psychologist and I had to convince my GP to make the recommendation instead, who wasn’t very keen to do so because she’d only ever experienced me as a ‘happy’ person. (No surprise there, I’m not in the habit of blabbing my life story while someone performs a pap smear on me). Apparently it isn’t quite the done thing to go around asking to be placed in a mental institution. Other people are meant to do that on your behalf when you’ve passed the point of reasonable sanity. Or something. This is really worrisome in itself – the amount of effort demanded of me to access a mental health care facility could easily act as barrier to many people who urgently need help.
Anyway. The clinic was good for me. I met wonderful people, staff and patients alike. I ate, finally. I managed to sleep. The psychologist assigned to me there was a wonderful and empathetic human being, and I will forever be grateful for her stabilising and humorous input in my life.
The psychiatrist, on the other hand…
Upon arriving at the clinic the psychiatrist on duty (let’s call her Dr. Lourens) had to perform an intake interview. What that basically means, I soon found out, is that shortly after checking in I was meant to sit in her office and answer questions for roughly an hour, after which she proceeded to diagnose me, only meeting me again two weeks later to check whether my medication was having an effect.
Maybe some psychiatrists actually do talk therapy, but this one certainly didn’t.
She barely even listened, only making brief eye contact in between the copious notes she was making on her iPad. There was a questionnaire and she was completing it. The task was clear: diagnose and prescribe. Next!
She wasn’t cold, or rude. She was just… very busy. And not very interested.
I’d just gone through a breakup, I explained to her. The guy had left me for a close friend of mine, but really it wasn’t quite that simple, because we were in an open relationship and…
“Open relationship..?” Dr. Lourens had interjected, peering at me over her glasses. Her office was roomy, bland, filled with medical handbooks. In between questions I sat staring out the window at the mountains on the horizon, waiting for her to finish typing. I felt tired, lost.
I tried explaining. Just as I was exploring the idea of non-monogamy I met this guy in a bar, he and I and my friend (the one he ended up leaving me for) landed up having a threesome that night but it was nice, it was a fun and warm experience. And then after that he and I really hit it off, so we continued our relationship…
“Do you often become drunk?” Dr. Lourens asked. “And then partake in risky sexual behaviour?”
No. I wasn’t drunk that night. I was high, though, I said. I thought I should probably mention the cocaine use, it felt relevant. (I took a six-month detour into regular drug use during this time, which I wrote about here. It was very foolish but also a valuable learning and living experience). Anyway – that was my first threesome and it didn’t feel risky at all, it was with someone I knew well and with someone else who moved in my circles, someone who knew lots of my friends. He was nice. Respectful. Funny. Sure, we were high but there was never a sense of danger, only excitement and curiosity.
“Do you often participate in risky sexual encounters?”
How to explain myself to this middle-aged woman, who had Bible verses stuck to her cabinets, who had a picture of her grandchild up next to her textbooks?
Seen through her eyes, my life seemed positively insane.
“Yes, once,” I said. “Well, it wasn’t risky. I had a four-way, again with this guy (Lance) and two female friends.” It had been a fun night. We were celebrating my graduation, running around in my toga and smoking rolled cigarettes in between sessions of enthusiastic friskiness. We laughed a lot. We shared life stories. I felt powerful and beautiful and enveloped in friendship. I tried explaining to Dr. Lourens that none of this was sitting badly in my soul, that it fit well with my then approach to life and love (which is basically ‘do no harm, and also, don’t avoid doing things just because they’re considered taboo’).
She made notes. I suspected they were not flattering. Then we moved on to family history. Here I had quite a bit to say. There’s a lot of depression in my family, a few suicides, and, I mentioned, most of my shrinks have seemed to think that my dad has undiagnosed Bipolar Disorder.
“Bipolar Disorder?” Dr. Lourens perked up. “Which type, do you know?”
I have no idea. He is undiagnosed, after all. Anyway, from the undergrad psychology I myself have taken I thought my dad might have Narcissistic Personality Disorder instead, or perhaps Borderline Personality Disorder. Something, in any case. Maybe all of the things.
Dr. Lourens was making notes. Timidly, I floated a suggestion past her:
“Could I perhaps have CPTSD?”
A few weeks before, a friend had suggested this to me. I’d never heard of it but after some quick googling I found out that CPTSD stands for “Complex Post-Traumatic Stress Disorder” and that it occurs from repeated trauma, often in the context of an abusive childhood. Sounded plausible to me.
Dr. Lourens frowned. For a moment I thought she might not know what I was referring to but then she shook her head sharply.
“That only affects children who were sexually abused,” she said.
Oh well, in that case. I felt foolish for suggesting it. Sexual abuse was the only form of abuse that did not take place in my childhood, so clearly I couldn’t have this disorder then.
Could I just be burnt-out? I tried explaining the past six months to her: I’d just finished my Master’s degree when my long-term boyfriend and I broke up. Then I woke up in a new relationship, one with a cocaine addict (who was also a good friend and a kind person, those are not paradoxes), and we were trying non-monogamy and doing too many drugs, and then suddenly he left me and also I lost a close friend, and I was under pressure to perform at work and publish an academic paper, fast becoming broke, exhausted…
“Do you have a lot of mood swings?”
Well…I’d googled ‘effects of regular cocaine use’. Does it count as mood swings when you’re feeling on top of the world and super motivated, and then you spend a sleepless night wishing for death to take you, but only after doing cocaine? (Which, those days, was often).
“I’m quite… intense,” I tried to explain. “But apart from the past six months, I don’t think I’d describe myself as having mood swings. Well, maybe a bit. I AM quite weepy. And I did struggle with anxiety a few years back and for six months the doctor put me on a mild anti-depressant, but that was while I was holding down two jobs and studying and…”
I have felt depressed before, but I’ve never actually thought that I have depression. My blue moods have always felt too transient, situation-bound, or like deep upwellings of sadness for a world which is legitimately broken. If I do have a mental illness, I always thought, then it would be an anxiety disorder, and even that has never felt quite like the right fit. Rather, I considered myself emotional, high-strung maybe, but also emotionally vast in a healthy way. But perhaps I’d internalised the stigma around mental illness? Perhaps I was in denial about my own mental ill-health?
The intake interview was over. Dr. Lourens leaned over, taking her reading glasses off.
“Would you like to know what I think?” she said.
Yes. Yes, I really would. Perhaps she’d find a description that makes perfect sense, perhaps there is a word out there that might fit so wonderfully that I could stop feeling lost and exhausted and feel understood instead.
“I think you have Bipolar Disorder.” She looked down at her notes, ticking things off. “It fits with the risky sex, drugs and thrill-seeking behaviour, with the mood swings, and your family history also confirms it.”
Oh. She’s still hung-up on the four-way, isn’t she?
“But aren’t you supposed to have manic episodes when you have Bipolar Disorder, moments where you go shopping and spend all your money or feel powerful and amazing? I mean, I get that one might say I have the down-swings, but I don’t recognise that mania within me…” I suggested.
“That’s Type I you’re describing,” Dr. Lourens interjected. “Type II only requires instances of hypomania, and it’s more often characterised by frequent bouts of depression. Many people with Type II Bipolar Disorder lead normal lives for a long time before they’re diagnosed.”
It didn’t fit. It didn’t feel right. How could I have reached the age of 28 without anyone clocking that I might be bipolar?
Nobody had ever told me that they experienced my intensity as mental illness, not even the long-term boyfriends I’ve had, not even my family. I’d always felt…emotionally diverse, rather than ill.
“Just consider it,” Dr. Lourens said, handing me two pamphlets. “There’s no harm in thinking about it. In the meantime we’ll prescribe some medication and see whether that makes you feel better, and if it does then that’ll be confirmation.”
I supposed there was indeed no harm in thinking about it. And I would have swallowed almost anything if it might make me feel better, so I agreed to the medication.
And that was it. Without informing me, Dr. Lourens then notified my medical insurance (and thus the world) that I have Bipolar Disorder. It still says so in my files. I have never even vaguely consented to that.
Two weeks later I met up with Dr. Lourens again and we discussed my medication, which we were gradually building up to a therapeutic dose. I had heard rumours in the clinic… at least two thirds of the patients there had been diagnosed with Bipolar Type II as well. It was starting to seem like a catch-all for “I have unpleasant emotions and the doctor didn’t have time to listen fully to my personal history”. So I retained my scepticism, caught between the desire to be honest with myself and the vague sense that something was wrong with my diagnosis.
I read up about Bipolar Type II. Some of the symptoms somewhat resonated. During hypomania, it says, a person might have a decreased need for sleep. And indeed, when I’m in the throes of an interesting project or am excited about something I often lie awake at night with my mind bouncing around endlessly (it’s much better now because of healthy living and mindfulness practices). I don’t have exaggerated self-confidence (except on cocaine), but my mind does sometimes fly rapidly from one idea to the next. And I talk quite fast.
“People experiencing hypomanic episodes are often quite pleasant to be around. They can often seem like the “life of the party” — making jokes, taking an intense interest in other people and activities, and infecting others with their positive mood.” (WebMD)
That felt trueish. I’m fun to have at parties. I’m likeable. I didn’t think I was pathologically fun, but I suppose you could make a case for hypomania.
The depression bit fit less well, actually. I did experience, like I said, times of sadness. But they didn’t feel like general “low-ness”, lethargy, feelings of worthlessness, or loss of pleasure. They felt like hormones. And cocaine comedowns. And like sadness because my boyfriend dumped me. And like stuff I might need to sort out from my childhood.
I’m a cheerful person. I’m a cheerful person who also cries a lot. I’m not forcing my cheer, nor faking it; I am genuinely enthusiastic about nearly everything, and the idea that this might be a disease instead of a nice part of my personality sent me spiralling into self-doubt.
So I phoned my family and my ex-boyfriends. “Do you think I have Bipolar Disorder?” I asked them all. They all seemed doubtful. I asked my friends. They didn’t think so either.
But I gave the meds a shot anyway. We upped the dose gradually. I felt better, but that might have been because I wasn’t using cocaine. I left the clinic after three weeks and resumed my life and things were good. Still intense, still weepy. I was scared that the pills might blunt the edge of my emotional experiences but they didn’t, I still thought people were really interesting and I still had lots of energy (usually) and beautiful things still moved me to tears. I stayed off cocaine, even attending NA meetings a few times before I stopped because introducing myself as an addict felt like a lie.
That’s the thing with all the terms, all the diagnoses: I couldn’t bring myself to believe them. On the one hand they felt limiting, on the other they felt simply untrue. I’d sit in a meeting and say “Hi, I’m Sage and I’m an addict” and I’d feel like a fraud. I have made some bad choices on cocaine but I’m still not categorically against drugs. I don’t fold and phone my dealer every time I have a sip of wine.
I know that I tend to adopt new habits too fast, I know that I smoke like a chimney and that I tend towards unhealthy coping mechanisms. The problem there, it still feels to me, does not lie with addiction per se but with lack of good coping strategies and emotional regulation.
The same applies to having Bipolar Disorder – I’d talk to some other people who have been diagnosed as well, and I’d feel as if I was lying to them.
Like I was trying to be part of a club I didn’t belong to. I hadn’t spent half my life wondering what could be wrong with me. I hadn’t searched fruitlessly for the right kind of medication until the doctor found the exact right combination and my mood began settling. I don’t have a string of hurt and baffled ex-lovers and family members behind me. I didn’t feel like I get to call myself mentally ill, because I haven’t suffered, not in that way at least, not enough to find respite in a psychiatric diagnosis. But perhaps, I kept thinking, perhaps everybody feels this way? Perhaps we genuinely can’t see our own mental illness because of our blind spots?
In August 2018 I had my follow-up interview with Dr. Lourens. I felt good, calm. I still didn’t think I had Bipolar Disorder, but I was still taking the meds, just in case (but we weren’t even up to full dose yet, the pills require a gradual build-up). Dr. Lourens seemed baffled when she saw me. I gathered that the medication wasn’t supposed to work this fast, I wasn’t supposed to look this serene and well… this together yet. So she over-compensated, and that’s where she finally lost me.
“It’s amazing,” she said, leaning back. “Do you remember your intake interview? You could barely sit still, you were fidgeting all the time. You were nervy, strung-up. The medication seems to be working wonderfully.”
She was trying to convince me she’d made the right diagnosis, I realised. And she was misremembering our first encounter entirely in service of her argument. The first time we’d met, I’d barely moved. I was exhausted, sitting limp and still, staring out the window. If anything, I was noticeably more fidgety this time around.
So there I decided I was done with it. I contacted some friends and family members, asking them to act as my accountability partners as I took myself gradually off the meds again. I let my GP know. My colleagues were mostly in the loop. I wasn’t using drugs (although soon after that I encountered magic mushrooms, but that’s a whole other story), I wasn’t in a romantic relationship, I was doing yoga every day, I was reading self-help books, I felt really stable. I watched myself for plausible signs of hypomania or of depression. Nothing.
I fell in love. I tried non-monogamy again. I felt scared and vulnerable but okay. I started relaxing.
It was exactly a year after my stay in the clinic (thus in June 2019) that everything came crashing down again.
I wrote about that already so I’ll try not to repeat myself too much. What I haven’t quite discussed before, though, is how my life had changed over that past year, between June 2018 and June 2019. I had good habits in place that I now roughly managed to maintain. I had a much larger emotional vocabulary. I was much more self-aware. I had since adopted a dog, was living on a beautiful farm, was maintaining supportive friendships.
So even though the bottom dropped out of my world again, I had me. I had my knowledge of me. I had friends I wasn’t hiding facts from. I had the sense, deep in my gut, that I would have my own back and that I could trust my truth.
My truth led me down a path of learning more about trauma. Suddenly everything around me seemed to point in that direction. The notion of CPTSD floated back around, and it turns out it isn’t a disorder that only kids who were sexually abused can get. Also, I learned that CPTSD isn’t in the DSM-5 (the manual psychiatrists use to make diagnoses), explaining why Dr. Lourens had been so dismissive of it.
A few months ago I came across this piece in a book by Pete Walker titled Complex PTSD – from surviving to thriving:
“I have witnessed many clients with Cptsd misdiagnosed with various anxiety and depressive disorders. Moreover, many are also unfairly and inaccurately labeled with bipolar, narcissistic, codependent, autistic spectrum and borderline disorders. (This is not to say that Cptsd does not sometimes co-occur with these disorders.) (…) Furthermore, this is not to say that those so misdiagnosed do not have issues that are similar and correlative with the disorders above. The key point is that these labels are incomplete descriptions of what the survivor is actually afflicted with. Reducing Cptsd to “panic disorder” is like calling food allergies chronically itchy eyes. Over-focusing treatment on the symptoms of panic in the former case and eye health in the latter does little to get at root causes. Feelings of panic or itchiness in the eyes can be masked with medication, but all the associated problems that cause these symptoms will remain untreated. Moreover, most of the diagnoses mentioned above are typically treated as innate characterological defects rather than as learned maladaptations to stress – adaptations that survivors were forced to learn as traumatized children. And, most importantly, because these adaptations were learned, they can often be extinguished or significantly diminished, and replaced with more functional adaptations to stress. In this vein, I believe that many substance and process addictions also begin as misguided, maladaptations to parental abuse and abandonment. They are early adaptations that are attempts to soothe and distract from the mental, emotional and physical pain of Cptsd.”
And the penny dropped. I’d found something that resonated. I don’t fucking care if it’s not in the DSM-5. THIS feels true. I read and I read and I cried a lot as I read because finally, FINALLY, someone was explaining myself to me in a way that felt true. It felt like this was honouring what was happening in my heart, instead of explaining it away, pathologising it, labelling it, medicating it – dismissing it, really.
But. I have days when I wonder. Since entering my newest cycle of pain (there’s something about the month of June) I have caught myself wondering: Could I have depression? I run through the symptoms: Low energy. Check. Seemingly inexplicable weeping. Check. Or could I be bipolar? After all this time, could my psychiatrist have been right?
I don’t know for sure. I don’t think she was right, I think rather than bipolar I am still traumatised and also just plain sad, because a lot of difficult things have been happening in my life. At night I lie in bed breathing deeply and I listen to the beat of my heart, and underneath all the pain I feel a river of life, of strength, coursing through me. I don’t feel at the mercy of my moods, but rather at odds with the different parts of me, with the part that is scared for my life and the part that knows everything is as it should be. But this could be true AND I might be bipolar. So am I?
Time and time again, I then return to this question: Does it matter?
The empowering thing about claiming my own trauma is that there are things I can do about it. I can learn about my attachment style and my coping mechanisms, I can gradually learn to release what is no longer working for me and adopt new strategies to life. I can recognise my own fear when it comes up. I can do deep stretches and yoga and take long walks; and importantly, all those things will not only bring temporary relief but will contribute to lasting change, to rewiring my brain into understanding that I am safe now.
That’s the difference: with a diagnosis like Bipolar Disorder or Major Depression, you do what you can, you take the meds if they help, you surround yourself with a support network, but basically the diagnosis is for life, or at least potentially for life. You might get relief but you will still have this sword hanging over your head, waiting to drop. And I think that getting caught up in the story of this disorder, of depression or mania or anxiety, can make things worse instead of better. It can be disempowering.
Far be it from me to say that having Bipolar Disorder (or depression or any number of psychiatric diagnoses) is not valid. I think those terms are extremely useful. I think that medication has helped a huge number of people. I think that many people have felt tremendous relief in giving a name to their experience. I think we should destigmatise mental illness.
But I also think it’s really dangerous to give one person, a stranger with a medical degree and a long list of syndromes in front of them, this much power. Usually, if you’re diagnosed with cancer or diabetes or Alzheimer’s, doctors run a whole lot of tests. They see you again and again. They consult with each other. I know you can’t exactly do the same with disorders of the mind, but it feels reckless to me that a psychiatrist is able to make a diagnosis based on a single consultation.
I am not okay with this. I am not okay with having my life story, my spiritual and mental and physical history, my traumas, my genes, my choices, reduced to a quick diagnosis, a diagnosis made without taking my own opinion into account.
I officially have this disorder now, it’s a public fact, whether I like it or not, unless I am willing to spend huge amounts of money to get another psychiatrist to overturn the diagnosis. And if I contest it doctors can simply say “methinks the lady doth protest too much”. Which is indeed what my psychiatrist ended up saying to me, asking me that last time we met: “Why are you so against this diagnosis? Could it perhaps be that you’re resisting it because it actually feels true?”
No, Dr. Lourens. I am not resisting this diagnosis because it feels true. I will not be shrunk into doubting myself. I will not be enticed to bow to your superior knowledge. I am the expert here. No amount of guidelines and medical information and manuals can provide you with the insight needed to override my own innate wisdom. No more.
Medication is an important part of the arsenal of tools to help people who are struggling. So are psychiatric clinics, and diagnoses themselves. But in the clinic I met a frightening amount of people who land up there again and again, stuck, changing their medication when the pills stop working, taking huge amounts of sleeping aids (all legally prescribed), spending large sums on psychiatrists and counselling, and yet landing up there over and over because life simply is not becoming more bearable. It’s heartbreaking. It’s frightening.
And I believe that there is a better way, there must be a better way. It’s sad for me that many holistic practices are frowned upon by the medical world, thus pitting “science” against “the quacks” in a way that does not serve the actual people. It’s sad that most of the ill people I met at the clinic left with no more understanding of their own psyches than they had come with, taught only to depend on the doctor’s better knowledge and her prescription pad.
It’s sad that our discomfort is medicated away instead of accepted and investigated. It’s sad that we are not encouraged to learn from our unpleasant emotions, but told instead to view any strong emotion with suspicion. It’s sad also that alternative ways of living can arouse such suspicion in a doctor that they are considered symptoms of mental illness. It’s sad that our truths about ourselves are being ignored in favour of a stranger’s opinion. It’s sad that our stories are seen as symptoms instead of the rich tapestries they really are.
So: I might be bipolar. I might have a whole lot of things, as I discover whenever I go down the google rabbit hole. But unless these labels are helping me on my journey, I categorically reject them.
Instead I am taking magic mushrooms and learning martial arts and dancing in my kitchen and weeping on my yoga mat. And talking to my friends. And to wise helpers. And to Life.
I am here. It’s hard. The truth is that a psychiatric diagnosis isn’t going to make it easier.