Ten years ago, when I was first diagnosed with bipolar disorder, I was working with a psychiatrist who wanted me to alert him at the first hint of a creative thought. Whether it was an article idea or, God forbid, a concept for a book — any scribbling into a notebook, because that was surely an indication that I was experiencing hypomania and needed a higher dose or a different kind of antipsychotic — he wanted for me to get in touch. He put the fear of God into me that any sign of life in my comatose brain or body meant that I was spiking before crashing into a debilitating depression.
Even after I left him to work with a much more skilled physician, I had this paranoia about feeling good: “Am I hypomanic?” I would ask my psychiatrist. “I don’t want to die today, which clearly means I’m hypomanic, right?” Every emotion and response to life’s events became a symptom. I categorized all crying sessions as “depression,” and filed any type of excitement or energy under “mania.” The terrain between the two, or what we consider “normal,” was a thin thread of land that I visited as often as the Gaza Strip.
But we really should widen our concept of “normal” — challenge ourselves to see our responses, temperaments, and our very selves as more US than illness — explains mental health expert John McManamy in his new book, Not Just Up and Down: Understanding Mood in Bipolar Disorder, the first of aBipolar Expert Series. He writes:
I had no idea when I began this book of the emphasis I would give to “normal.” Once I got several chapters in, though, it became clear I needed to regard normal as a mood episode unto itself, as worthy of our respect as depression and mania and hypomania and anxiety. This was one of those Newton-under-the-apple tree moments for me. From there, “normal” literally took over the book.
If our “normal” fails us, our depressions and manias and anxieties are sure to follow suit. Or, looking at it from a slightly different perspective, if our normal is too fragile, depression and mania and anxiety are going to come crashing through the door. This is where the Socratic injunction to “know thyself” acquires a new sense of urgency.
I’ve known McManamy personally, and have respected his work, for 10 years. We were among the first mental-health bloggers out there going public with our stories, and possibly the only two people at the time who were interjecting a sense of humor into this often somber subject matter. In his past writings and with this book, he has done a masterful job of helping people become experts on their illness and educating them about the history of psychiatry — especially the development of diagnoses included in all versions of the Diagnostic and Statistical Manual of Mental Disorders — so that they can be well-informed participants in their recovery and not be afraid to think for themselves. “My goal in this book is to help make you an expert patient,” he writes in the first chapter, because “patients who take the lead in learning about their illness and in managing their own recovery fare far better than those who simply wait for things to happen.”
McManamy is a perfect guide to help others navigate the messy terrain of bipolar disorder, because not only does he suffer from the illness himself, he also has a wealth of knowledge tucked away in his noggin. He’s studied virtually every classic text on psychiatry and mood disorders — quoting a variety of experts dating back to Hippocrates — and has attended (and sometimes presented at) practically every conference held by the American Psychiatric Association and other professional psychiatric organizations.
All of the chapters contain entertaining anecdotes, interesting studies, and sound advice, but I especially loved what he had to say about “normal,” because going there is brave: What we know is extremely muddled, unclear, and confusing. As McManamy rightly points out, our neat diagnoses confer on us a sense of absolution: “It was my depression that kept me from remembering your birthday, it wasn’t me!” or “My mania took over when I hit on your girlfriend, it’s not my fault!” We see our depression and mania as entities apart from ourselves, even giving them names like “black dog” (Winston Churchill). A sense of detachment benefits us. McManamy writes:
“Normal” doesn’t let us off the hook so easily. It’s personal, it’s painful. We have to come to terms with ourselves. In the long run, though, our enquiry is the source of our salvation. Normal, as we have seen, can be an extremely frightening place. But it is also the repository of all that is good inside us, together with all our hopes and dreams.
I appreciate his insights right now, because I’m starting to reevaluate some of the beliefs I’ve held about my illness for 25 years … like maybe several of those moments I categorized as “depressed” or “manic” were just me. I am a deep thinkerwho tends to reflect (okay, obsess) on the suffering of the world. Maybe that’s my “normal” and not all “illness.” My playfulness is also who I am, not necessarily hypomania.
McManamy’s words made me think about a conversation I had with a friend in 2012.
My husband didn’t have any work at the time. I was working full-time as a government consultant. And both of my kids weren’t sleeping, which then led to a case of terrible insomnia for me. We were in family therapy, which seemed to be making things worse. I was on so much lithium that I was visibly shaking at work meetings and swim practices, which would provoke some really stupid and hurtful questions about my health from people.
“I just want so badly to die,” I said to my friend. “I don’t understand why God won’t allow me to die. Or at least help me find a medication that works.”
“No offense,” he told me, “but anyone in your position would want to kill herself. What you’re feeling is perfectly normal.”
Maybe not normal for a resilient, well-adjusted person who can roll with life’s punches. But for an extremely sensitive person who needs sleep, a job where she feels like she’s making a difference, and a sense of stability at home? Yeah, maybe my response was normal.
McManamy adeptly illustrates the mistake we often make with assigning our temperament to a diagnosis with this example:
Two women are dancing on tables. It’s not the dancing on tables that is at issue – it’s who is dancing on tables. One is Marilyn Monroe. The other is your stereotypical librarian. Marilyn is obviously just being Marilyn. It’s the librarian we have to worry about. Then again, she may be fine.
Throughout the book, he demands that his readers get to know themselves, to evaluate their history of symptoms and life circumstances, and to navel-gaze a bit and explore themselves as if they were a foreign country for which they desire a visa. That knowledge, he asserts, is going to help you expand the time you spend in the normal Gaza Strip of your life, and better manage your episodes in the seas ofdepression and mania that border. Normal is what we’ve striving for, and ironically, we might be there more often than we think we are. Writes McManamy:
Normal is the true starting point in our journey to know thyself, as well as the final destination. In normal, we find our sense of home, as well as our sense of coming home. In one sense, our journey never ends. In another, we’ve already arrived, even if we don’t know it yet. Welcome to normal. Welcome home.