CW: Mental Health Treatment, Diagnosis, being diagnosed, Bipolar, BPD, Mental Illnesses, childhood trauma, the effects of mental illnesses, Eating Disorders
TW: binge eating, self-harm, mania, emotional trauma, body image and self-worth
Anxiety, depression, paranoia, personality disorder, panic attacks – the list goes on. In the UK it’s hard enough to actually get a diagnosis of our mental illnesses, let alone one that is accurate enough to cover all the bases and keep up to date with how it develops. It’s a common misconception that once you’re told you have an illness, it stays the same – it doesn’t – quite often a diagnosis should be expanded on, elaborated and qualified in a new context, routinely.
However, we aren’t afforded such a system as of yet, at least publicly, and it doesn’t seem like we will anytime soon. There are scores of people across the internet talking about how once they fight for their diagnosis, and if they push against it or ask for further consultations, they are quickly dismissed and discharged. I was one of them.
The system is a shit show.
So, I thought I’d give a little insight into the complexities of not only being given contentious diagnoses but also what they mean and living with them.
Last summer I was diagnosed bipolar affective disorder. Bipolar is generally categorised into two columns, bipolar 1 and bipolar 2. There isn’t much that sets them apart, other than:
- Bipolar 1; is generally given if you have had an episode of mania which lasted more than a week – it isn’t defined by depressive episodes, however, you may experience them (but not everybody does).
- Bipolar 2; would be if you have had both an episode of depression and hypomania.
In America, but not recognised internationally, the term ‘rapid cycling’ is frequently cited. It is basically a descriptor for those of us that cycle a lot more than originally thought to be the norm of bipolar disorder. A diagnosis is given generally based on experiencing one episode of mania/hypomania. Those that cycle rapidly would, or could, cycle multiple times in an hour, a day, a week, in medical terms they say 4 or more.
A lot of the stigma behind mania and its lesser known cousin, hypomania, is what gives bipolar a bad name. But, semantically speaking, bipolar just means “having or relating to two poles or extremities”. So, if you’re interested at all in society, politics etc. you know that most things work in this way. We have the far-right and the far-left, we have capitalism and communism, male and female. Societal norms tend to come in a binary, which is problematic enough when we are trying to dismantle the confines of our environment – but when given such a rigid diagnosis to something based on our mood and emotions, it can be a pain.
Anyway, in this instance the two poles are mania/hypomania and depression.
There’s very subtle differences between mania and hypomania, I, personally, feel that I have suffered with both – but more so hypomania. What does that look like?
Both are a heightened sense of energy, we can become productive and fast-paced on the good end of it or reckless and out of control on the bad side. It can trigger insomnia in me and racing thoughts, I become impulsive and implosive – leading to self-destructive behaviour. Mania, speaking from a lot of experience, is like being on coke. You speak a mile a minute, you disconnect from the outside world and only think inwards and can be really intrusive to other people’s space and boundaries.
We’ve all met that coked up asshole at a party, I’ve been that guy, you lose the ability to confine your thoughts or wait for others to speak and the silences can be filled with those sudden pangs of anxiety. It’s these spikes in mood and disconnection from both yourself and others that push people to self-medicate. Uppers when you’re low and downers when you’re high. Life in perpetual flux.
What it has meant for me is broad, and frankly, I don’t know if I completely understand it all. But I have found myself acting aggressively, acting out and spending all of my money without care and on a whim. It’s also within these states that I have found myself being the most abusive to those around me – not caring about their welfare, the effects I’m having on their life and having complete disregard for any responsibility I may hold.
Obviously, the complete opposite is what could constitute as a depressive episode – but it isn’t always that simple. When I’m depressed I can find myself in a heightened state of emotions, crying for no reason and having an intense, eclectic mix of pain and sorrow crackling on the surface. I go to bed earlier, wake up later – if at all. I give up on anything I like, opting for easy fixes like Netflix – and food – this is where I delve into my binge eating disorder. Another layer, *dramatic music*.
A buddy that jumps on the d-train is low self-esteem. I can’t look at myself in the mirror, I loathe myself and feel disgusted with my appearance. I stop looking after myself, I lose the will and motivation to do anything remotely active and I comfort eat. I mean, really comfort eat. Binge eating disorder isn’t just a made-up thing, I know, I thought that too.
Binge eating can manifest in ways that you’d least expect and doesn’t necessarily mean you will eat a lot or consistently. What it does mean is that you try and fill your emptiness, try and absolve yourself from whatever pain you’re feeling – or not feeling in many cases – you’re feeding that dark passenger and it feels good, until it feels fucking awful.
Binge-eating is self-harming, plain and simple. It’s methodical, overwhelming and well thought out (most of the time). It’s something I’ve always done, since a young age. I learnt how to make cake mix as a toddler baking with my Mum and so I found my first tool. Binging has been replaced sometimes in my life with extreme fasting, dieting and starvation. I dropped almost 15kg in a year once and on a person my frame, it shredded me away.
What I have opted for are things that I like, but things no one should eat in such vast quantities. Cookie dough, cake mix, jumbo bags of sweets, full pots of ice-cream, take away pizza and homemade mac n’ cheese. The cookie dough and cake mix can be frozen and divided, so on good weeks where binging is momentary and a quick fix, I can whip it out of the freezer and be on my merry way. Other times that sinking feeling takes over and the impulse to binge, to self-harm, is so intense I’ll just get up and fly through the streets, looking for an open shop that I can buy as much as I can of whatever looks remotely disgusting.
Those times are the hardest. The secretive, deceptive and well-planned times are manageable and not entirely overwhelming. It’s the times where you think you’ll die if you don’t do it or that you feel so low in mood that you need to do it to survive. Those are the scariest.
However, as I stated before, that one or two worded diagnosis often means nothing. Daniel, bipolar affective disorder; hypomania and depressive episodes. Where’s the problems with food? Where’s the ongoing struggle with self-image that goes beyond dissatisfaction and is in the realms of body dysmorphia and dissociation, or what about the Daniel that can’t hold down a relationship without spiralling, self-destructing and completely crumbling?
It was that final point which was the most distressing to have to go through after my diagnosis, thinking that being labelled as ‘bipolar’ would liberate me from previous experiences. It was naïve, but that’s how it felt. Shortly after being put on meds (which sedated me and pushed me into a deep depression for seven months, but that’s a different post) I spiralled again at a time of high stress. I was in a relationship, moving home, had started the PGCE and was about to start my first placement – I imploded, self-destructed.
It was stupendous, a truly spectacular fireworks show. It left me feeling like I did after every other failed relationship; deflated and resigned to the fact that I can’t love or be loved – that I was broken.
I’ve spoken before about self-diagnosis and here’s where mine came in. I was determined to not have this happen again and I had a good idea what was a good fit to describe the exact motions that I was going through – albeit something I had been reluctant to delve into due to the immense stigma attached to it. I was moving towards the idea of personality disorders, Borderline Personality Disorder to be exact.
Personality disorders are divided into three groupings: suspicious, emotional/impulsive and anxious. So, within those you have your paranoid/schizophrenic, your Borderline/narcissistic and the dependent/obsessive compulsive – those are examples, not definitive.
What is really difficult about a BPD diagnosis is that it overlaps with many symptoms that I already suffer with – or as I view it more so now, is that my symptoms of bipolar actually mask those of BPD. A starting point in understanding how it is defined and diagnosed is with having to check at least 5 of the following symptoms:
This list, outlined by Mind in the screenshot above, is where I saw myself. So, I sought out professional help, and found a psychotherapist dealing especially with emotional and behavioural problems. The thing is with BPD, is that it’s somewhat treatable and with specialist therapy – which I’d either have to win the lottery to get or do as I am currently and wait 6 months for the NHS – you can actually overcome many of the symptoms.
BPD is often something that emerges in those that are described as being, and always having been, hyper sensitive and emotional – generally from a young age. Like Bipolar, health professionals don’t actually have many answers as to why it occurs, generally speculating across a broad spectrum of reasonings – genetic factors, chemical imbalances, inherited, environmental. How I would describe it is as missing a, or having a limited, set of certain emotional and interpersonal tools.
The first half of my life, and moving into my first year of secondary school, was quite traumatic – especially my early years. I was exposed to a lot of very violent, angry and destructive scenarios as a toddler, leading up to the eventual split of my parents. I am blessed to have two parents who both come from quite troubling backgrounds – actually leading to my Dad being diagnosed with BPD and Bipolar 1 in his 40s.
So, I received a great deal of extremes. Extreme shouting, extreme emotional abuse, extreme conflict, extreme bullying, extreme reactions, extreme control. I didn’t have parents who were capable of showing and expressing emotions well, if at all – meaning that they generally just followed in their parent’s (read: father’s) abusive footsteps and continued the cycle. This tends to be a common denominator amongst people I know with BPD – they weren’t given the tools needed to navigate relationships, platonic or otherwise.
How has that manifested in my life? What can BPD look like? I’ve found myself overcoming, or learning to confront, address and combat many of my issues whilst developing new tools. Such as:
I struggle with criticism and lack of support, not having supportive people around me – or those that actively seek to undermine my achievements or aspirations – means that I quite often don’t believe in myself or can’t see that I have any worth.
I need direct social queues. I lack the ability to be able to know if someone likes me or not. Sexual advances are easy. I understand, mostly, when someone wants to fuck; however, sometimes I really need someone to come up and tell me “hey, you’re cool, I like and appreciate you” otherwise I go with the default that they hate me. That has been an integral part of why I find making friends or sustaining friendships hard.
Because I feel overwhelmed when a lot is going on at once, either resulting from me stress or emotions, I break down. It can be a sustained and gradual break down coupled with triggering a manic episode, self-medicating and shortly followed by depression. It results in me shedding all necessary stress. Therefore, if I am in a relationship I tend to grow to resent them, classing them as a burden and someone I don’t need in my life anymore. It can often feel hateful and all-round negative, I push them away and don’t want them interfering or trying to stop my break down as it is a well-orchestrated mess – allowing me to get to a point where there’s less stress.
I don’t have a strong idea or image of who I am. That sounds really cliché, borderline hippy, but it’s true. I don’t really know how to place who I am or define myself. That is certainly getting better, but it requires learning a lot of tools for self-love and acceptance. I didn’t receive affection or praise as a child, I wasn’t in a conventionally loving family. The majority of what I was taught has been negative and it’s quite strange how that pops up in life. My identity issues lead me into not sticking with hobbies, quitting things prematurely, being super eager to emulate another persona or being a people pleaser – becoming who I think the situation needs or requires of me to fit in and be accepted.
Lastly, and most importantly, BPD generally gives people a heightened sense of emotional intuitiveness – living in a perpetual fight or flight mode. When you feel emotions really strongly, you feel the good and the bad – a lot. If someone is fun and high energy – I become fun and high energy. If they’re low and quiet, I try and sustain a level of conversation that compensates, or I shut off from them and become slow and low-energy. I get lost in hysteria quite quickly in big groups and hate meeting lots of new people at once, it triggers intense social anxiety and I feel constantly under threat.
And I think that’s the best point to make about BPD, is threat. Having such a minimised set of tools to deal with all of these interpersonal interactions means that everyone is a potential threat. I can read people really well and I look out for any personality trait that could cause me harm and leave me abandoned or hurt. I recently met someone who I assumed had both bipolar and BPD, which was later confirmed to me and it was such a jarring experience. They were incredibly aggressive and full of high, negative energy, that when confronted with them I shut down. I downsized.
Having to navigate these emotional boundaries, as well as keep my life on track with regards to mood, can be exhausting – but not impossible. Talking about mental health and giving frank, honest accounts of what our lives are like is something I’m all here for. Recognised weeks like “Mental Health Awareness Week” I can honestly find reductive. Not because “every day should be mental health awareness week”, which it arguably should, but more so that what people talk about is often so simplistic and trivial – also so small in breadth – you’d be easily misled to believe that only depression and anxiety exist. Yet, what we should be talking about is the reality of mental health and mental illnesses and how it affects our human experience.
So, if any of that resonates with you – great. If not, hopefully it gives you a little bit of extra knowledge of what someone could be going through, or help you recognise perhaps behaviours in yourself or others that you’ve never really questioned before.
Bipolar and BPD are two very common, but very stigmatised, mental illnesses – 2 in 100 people having bipolar UK and 2.4 out of 100 having BPD, respectively. Talking about them in any capacity, but also just knowing about them, can help lift that.
Do some research, learn about mental illnesses.
You never know when you’ll be faced with them.
Sites used as reference: