Both Sides of the Couch
I am a psychiatrist. I am also a psychiatric patient. I have bipolar disorder and find myself on both sides of the psychiatric couch. This is my story.
It’s a story of denial, avoidance, remorse, humor, comfort, humanness and hope.
In February 2015, after 37 years of avoiding treatment, I walked into the office of the psychiatrist I continue to see to this day. It was the beginning of a journey of ownership that I had avoided for decades. It was quite humbling. After all, I felt that as a psychiatrist I wasn’t supposed to have this or any other psychiatric disorder. I felt like I was an airplane pilot suddenly forced to sit in coach. Humbling indeed.
But I think that being a psychiatrist with bipolar disorder offers me a unique perspective on delivering and receiving care. I now understand medication levels, hand tremors and weight gain. I’m now on two mood stabilizers, an antipsychotic and an antidepressant.
My bipolar closet door remained firmly shut for a very long time. This was true even though I was treating patients with exactly the same symptoms that I had. I have come to respect the power of the closet door. We all have closet doors, I think. We keep the painful, overwhelming and disturbing things locked away. And then we drug, we drink, we sex and we spend trying hard to outrun our inner storm clouds. We try to flee ourselves.
I grew up in a home where there was a premium placed on having a “stiff upper lip” and not expressing emotion. I learned to become an independent and self-sufficient kid. It was like living in a castle with the drawbridge pulled up, wandering around by myself behind impregnable walls. This caused me to distance myself from my own feelings and present myself as not needing comfort and care. It was a perfect storm that would lead to devastating consequences down the road.
It never occurred to me that I was ill. I could wake up with suicidal thoughts and then hospitalize patients that day who had the exact same impulses as me. Mostly my illness was invisible to others because I was a master at hiding my feelings and symptoms. It amazes me that I functioned through these years without receiving treatment.
At some point in my 30s, I began to prescribe myself antidepressants. This was a very bad decision and one which I came to deeply regret. Antidepressants can exacerbate bipolar cycling but since I didn’t see that I had bipolar disorder, I didn’t realize the consequences of prescribing to myself. I used strikingly poor judgement.
My depressive periods would typically last for a few months. I’d walk more slowly, feel exhausted, nap during the day, have impaired cognition and have endless ruminative suicidal thoughts. I never acted on my suicidal impulses. When depressed, I felt empty and vacant and it was as if I was looking at myself and the world through a darkly colored lens. I questioned my marriage, my friendships and my vocation.
My periods of hypomania caused me much more distress and have had more profound consequences for me. When hypomanic, my brain is hijacked, taken over by a flood of neurotransmitters that transport me to places I haven’t asked to go. I have thoughts I’d never have in my right mind, propelled into actions that my sane self would never do. It’s like being taken, against my will, to a place of insanity. My brain burns with the fire of ecstatic agitation and no amount of effort or will or wishing or prayer will stop the inevitable from happening. It is deeply disturbing, profoundly humbling and indescribably frightening to be forced to surrender in this way. I’m unable to stop an unstoppable force.
When hypomanic, I’m a surfer careening forward along the surface of a tidal wave moving at terrible speed. My sleep is disrupted but I have boundless energy. I’m chatty with strangers, skip meals and lose weight. I believe I can write novels and plays and my mood fluctuates between euphoria and irritable short-temperedness. I feel uber-confident without any self-doubt.
In January 2015, I was in the midst of my longest and most intense hypomanic period I’d ever had. I was sexually promiscuous and, using poor judgment, I placed myself in an unsafe situation. I was raped.
How can I ever forgive myself? How can I reconcile the guy who values decency, fidelity, health and safety with the guy who behaved contrary to those qualities? How can I come to terms? Can there ever be reconciliation?
The journey toward acceptance and reconciliation—as both patient and caregiver—began with the reality that I had no other option but to accept my diagnosis and engage in treatment. My health and safety, my marriage and my career were all at risk. I could no longer keep the closet door closed and deny the undeniable. The choice became: get treatment or destroy my life. The caregiver had to surrender to care.
Life is mysterious and requires us to surrender to things we can neither change nor, at times, comprehend. It’s a process of letting go, of falling toward a place of uncomfortable vulnerability and uncertainty. We are not always in charge. I hold no sway over my brains neurotransmitters and the behaviors that occur as they rage.
My journey has been a messy one. I’ve been honest and deceitful, open and secretive, brave and cowardly. We humans are so confident and so scared, so self-sufficient and so dependent, so courageous and so scared. I’ve taken a few big steps toward owning my messy self. Mine is a story that needn’t end with bows and ribbons. Honest ownership of my humanness is comforting enough.
I take some solace in remembering that we can often learn and grow during times of life’s greatest adversities. Some of our most precious times arise during periods of distress, adversity and vulnerability. I think that our willingness to fully engage in these most human of moments allows us to move forward on the path toward full ownership of who we are.
I’m trying hard not to be that self-sufficient kid who’s cut off from his internal emotional world and hiding behind castle walls. I’ve stepped out of those shadows and engaged in a messier but more human world. In so doing, the psychiatrist with bipolar disorder has written a new ending to an old story.
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