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Kathryn's Corner

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Kathryn Cohan Inviting In The Wolf
Living With Bipolar Disorder

I am very pleased to be asked to share with you my thoughts on living with bipolar disorder. The panelists who are speaking with me have very interesting and useful things to say about their lives. Like my colleagues, I have had a difficult time with this illness, and I too live by rules. The importance of the basics - eating, sleeping, taking medication as prescribed - and the rest of Abe's commandments are really important things to know about and to practice. Helena's accomplishments and her sense of humor about it all is a lesson to all of us about living our lives gracefully. It is not my intention to contradict either of these people, rather I hope to describe the different dance I do to the same drum.

I have bipolar I illness, rapid cycling type. I was diagnosed with it at the beginning of this decade, however I have lived with it for about 25 years. At the time of my diagnosis I was newly separated from my husband of twelve years, had been employed by the same Mental Health Center for eight years, had recently graduated from college seventeen years after my class, and was raising two small children in a house in a rural section of Rhode Island. Because of my clinical training in serious mental health problems, I brought to the diagnosis a good deal of theoretical knowledge about the illness. I thought I knew what to expect, and I thought I knew what I had to do. I really did do exactly what I was told to do by everyone. I took my medication as prescribed; I can honestly say I never missed a dose. I kept my life structured: I worked; spent time with friends; paid attention to my children; was mindful of stress; and joined a support group. I proceeded to get worse. No medication seemed to work effectively, my work suffered, my relationships suffered, my kids were out of control, my finances were a mess, my house was in chaos. This went on for a long time: gradually I became a completely unreliable employee, I lost all but one of my closest friends, I lost my ability to parent effectively, my house ended up in foreclosure, and I was hospitalized six times in a two-year period. I planned to kill myself after Christmas 1995, about five years after being diagnosed and despite the best psychiatric treatment and psychosocial indicators at the outset that appeared to bode well for recovery.

As I prepared to talk with you today, I reviewed the journey I've made in the past two years. I thought I'd talk with you about the rules I live by: I'm fanatical about sleep and limiting activities, and I do a few weird but helpful things like tanning to get artificial sunlight in the winter. And then I thought I'd talk about how I look at this disease a little differently: I experience it more as a disease of energy than of mood. In depression, what I have is too little energy, in mania I have too much. Much of my life is spent trying to nurture and balance energy. That is why I am a sleep hygiene fanatic: asleep right after Leno's monologue, awake with an alarm clock at 8:00 am every day, and I leave the shades open so my brain perceives the arrival of the morning gradually. In depressed, or low energy phase of the illness I live by a "one thing per day" rule - either I limit myself to driving only one place per day or I allow myself to accomplish only one task per day around the house. I've found that several consecutive days of "one thing per day" can refuel my energy supplies. When I am hypomanic, or high energy, I let my body do the work of burning it off, either by cleaning or exercise or repairing things. In high energy I try not to leave the house: high energy in a store invariably leads to overspending, high energy in a group of people invariably infects them and makes even more energy for me. I've begun to suspect that depression is the body's demand for rest in order to replenish energy and mania is the body's frantic attempt to reset itself if the energy gets too far out of balance. I have also learned to store reserves of energy, because I have finally come to understand that life is not predictable, and just because I have enough energy in "the bank" to handle routine demands, does not mean I have enough energy on hand if life throws me a curve. And life with two teenagers is full of curves.

Anyway, that's what I thought I'd talk about, but reflecting on how I live got me to thinking about why I live the way I do, and how is it that I have developed such a peculiar view of a well documented illness. And I realized some things.

First of all, once I was labeled with it, I treated this illness for years as if it was an impediment to a normal life. As I look back, I spent a lot of energy fighting with it. I treated it as if it was a wolf baying at my door, and I threw every medication in the arsenal at that door in order to reinforce it. When things finally unraveled for me in '95, and I finally agreed to try electroconvulsive therapy, things changed radically for me in relation to the illness.

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