January 25, 2006

Psst, I Got the Stuff

I’ve just been diagnosed as bipolar and I’m feeling really great about it!

This is serious, folks, and this is a nonfiction post. A couple of times on this blog I’ve alluded glancingly to the fact that I’ve been in treatment for depression over the years. In fact my life could be divided into two eras: the time when I was depressed and the time when I was treated for depression. The treatment, dating from my mid-thirties, has been successful – I’m a lot happier now than I was in my youth – but often I’ve felt that other problematic dimensions of my personality had been left untouched: dimensions of anxiety and anger, specifically.

I’m a kind, patient, peaceful person most of the time but all my life I’ve been prone to irritability over small slights and frustrations, and periodically I’ve been known to explode in anger at the drop of a hat, about almost nothing. (There’s a history of this in my father’s family.) It’s caused too much misery to me and to the people I love, who’ve received most of my anger. It was a big factor in the breakup of my first marriage. (I’m not going to link to that here; a link seems too flippant.) Over the years this trait has diminished in frequency, but on the occasions when it has resurfaced it has been as ugly as ever.

When I first got treated for depression my psychiatrist thought I might be bipolar too, but a brief trial of lithium proved unpleasant. Since then, self-help efforts augmented by antidepressants have got me through pretty well. But paradoxically, as I’ve felt happier about my life, I’ve been more susceptible to elation. It’s fun to feel elated, but the “up” periods are when it’s most likely for me to burst into anger. At the top of a mood curve, I sometimes explode. This is a bipolar symptom, and the conjunction between elation and anger is something my loved ones probably haven’t been aware of. My moods are most dangerous not when I’m down but when I’m up.

To make a long story short, I exploded in anger at my wife a week ago at a time when she and I had been feeling especially loving, especially optimistic about our relationship. I was shouting and cursing abusively and a millimeter away from violence, a line that thank God I have never crossed. The damage has not yet been fully repaired, but it was soon obvious to me that I needed finally to get help.

Yesterday I talked to my family doctor for a while and he agreed that I should get an evaluation from a psychiatrist. Health insurance companies nowadays are not especially eager to certify psychiatric consultations – you’re more likely to be sent to a talk therapist first – but my doctor advised me to state my case strongly, and the insurance company gave me a list of the four – count ‘em – psychiatrists in Austin who belong to their network and who are accepting new patients. I called one, and the receptionist wanted to give me an appointment in March, but I pleaded marital crisis and she very nicely found an opening that very day, if I could get there in thirty minutes. Which I could.

The psychiatrist was a nice young man out of Southern Methodist University, with no visible personality quirks, who interviewed me by repeating, with elaboration, the questions from the intake form I had filled out in his waiting room. He feels, and I agree, that I fit into the new, fluid category-in-progress of unspecified bipolar disorders which are treated with mood stabilizers, not with lithium. It’s a middle range, less severe than manic-depressive psychosis, but nevertheless troubling in people’s lives. I don’t go on spending sprees, I don’t talk through the night about grandiose plans and charter planes to other continents, but my moods are always cycling, nonstop – so rapidly, in fact, that the major reason for uncertainty about whether I fit the diagnostic category is that I don’t know if I’ve ever had an elation that lasted more than the requisite four days. As I wrote in my journal a few years ago and repeated in an earlier post, I am always happy and always sad.

The phases of mood are as palpable to me as the difference between sugar and salt, or between water and air. They are physiologically distinct states; I know them by touch; I practically greet them – sometimes with gladness, sometimes with trepidation – when they cross my threshold.

So the shrink gave me this stuff, and it’s supposed to take about a month to start showing effects. I’m wondering how it will affect my writing – I’ve sometimes thought that riding the mood curve was the real secret of creativity, and I’ve also thought that in order to write something really worthwhile I had to be either rejoicing or in despair. But I prefer to think that those romantic opinions were the syndrome justifying itself. I hope that by advancing in maturity I’ll find things to write about I haven’t found before. And if not – well, six books isn’t a bad total, and other things are more important. I pray that a third era in my life is beginning.

I’ve been wondering whether I should tell you all this, but when I first decided to become a writer, self-disclosure was part of the bargain. Now you know everything about me.