A friend of mine recently revealed that he has been diagnosed as bipolar. He has Bipolar II, the milder form, which perhaps explains why he is only being diagnosed in his 30s. I care very much about this friend. We met in rehab and connected easily. When you walk through the fire with somebody, you understand each other’s burns. He’s a handsome former varsity athlete who I could easily have a crush on but don’t. Instead I see him as an endearing, unruly little brother who I would very much like to drag by the ear out of the chaos that is his life and give a good talking-to.
His personal Treatment plan for his diagnosis consists of taking his antidepressant and not bothering with the mood stabilizer he has been given. Mania serves him well, he says, and feels amazing. Extra spending and possibly increased sexual activity notwithstanding, the high mood and boundless optimism feel too good, and he is simply not willing to give them up. As he talks, he sounds hurried, agitated by his own elation. He doesn’t hear me when I try to explain that mania, though it doesn’t feel like it, is as much a symptom of the illness as depression.
I understand why he’s thinking the way he’s thinking. I know something of his personal story, know the degree to which life has dealt him some tough blows recently, and the pain that he has suffered because of it. On some level, I wonder if he feels that he deserves the euphoria that mania gives him. After grappling with addiction and also anxiety, not to mention some seriously shitty luck, he deserves his moments of walking on sunshine.
I hung up the phone with him feeling very conflicted. I remain eternally grateful for the proper diagnosis, at long last, of my bipolar disorder. The medications have calmed me and centred me in ways I never thought possible. I am thankful for that. But I also remember missing being manic, almost grieving it. I spent the winter telling my husband I felt like a noodle: boring and limp and bland. I missed my tempestuousness, my intensity, the wild way I moved through the world. It was what I knew, and it was the only way I knew how to be me. Suddenly, even in the throes of addiction, I was a moderate, reasonable person, and I felt somehow that I had lost my fire, lost the best or the essence of what made me who I was. I came to understand, over time, though, that while the transition wasn’t an easy one, it was necessary for me, and for my family, and we were all better off for it.
Someone once said (and there is some dispute about who) that “I disagree with what you say, but I will defend to the death your right to say it”. This holds true not only for my friend, but for all those who are diagnosed with bipolar disorder, or any Mental Illness for that matter. I (or others) may not agree with choices made concerning medications or other treatment, but it the right of every person to decide what works for them. We must uphold that right, whether we agree with the actual decision or not. A diagnosis with mental illness is not a default imperative to medicate; it’s a framework for understanding the way you think about and react to the world and the people in it. It is a patient’s absolute and total right to make decisions about his or her own treatment (or lack thereof) unless refraining from treatment creates a risk of harm to self or others.
And so, I may not agree with his decision not to medicate fully, but I will defend to the death his right to make it.
For F, with love and respect and endless thanks for Dr. J Kumquat.
