Welcome to the Jungle, Revised Edition. Hilary T. Smith

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СКАЧАТЬ encounter. Your ray gun is strapped to your side; your freshly acquired jar of anti-psychotics and mood stabilizers is on your other hip. You step out of the doctor's office.

      WHAT JUST HAPPENED?

      Dealing with a bipolar diagnosis can be just as hard as the unfettered depressive or manic episodes that led up to it. It's like you've been hit by a truck, only to be told at the scene of the accident that you're going to be hit by several more trucks of steadily increasing size over the course of your life (have fun with that). For a while, it's hard to think about anything else but the fact that you're screwy enough to be considered mentally ill, and especially hard to accept a diagnosis of mental illness if you've always considered yourself a happy, healthy person. The diagnosis looms over your life, and you just want to rewind to a time before it happened. Can anything be the same again? How did they even decide I have bipolar?

      Being told you have a serious mental illness is a colossal mind fuck. In fact, some doctors and psychiatrists are now questioning whether it's even a good idea to tell people they have a “serious lifelong mental illness” when they experience something that looks like mania or depression. Why? Because having an authority figure like a doctor inform you that you are “mentally ill” gives you certain expectations (“I'm going to be unstable and need meds my whole life!”) that can actually make it harder for you to recover. The label of bipolar disorder can lead you to reinterpret your life in a certain way, giving special importance to mood while downplaying things like relationships, family dynamics, your ability to find meaning in life (or lack thereof) and various kinds of trauma which can play an equally large role in your ability to cope with life. What does “bipolar” even mean? And what does it really say about who you are? This chapter is about understanding what the people in white coats were thinking when they made the diagnosis. Even if you hate everything to do with jargon and psychiatry and labels like “bipolar,” you should know this stuff so you understand what (and who) you're dealing with.

      WHAT IS BIPOLAR, ANYWAY?

      Asking “What is bipolar?” is a little bit like asking “What is Christmas?” On the one hand, pretty much everyone thinks they “know” what Christmas is—yet if you asked ten different people, you'd get ten different answers: “Christmas is a Christian holy day celebrating Jesus's birthday.” “Christmas is a consumer holiday about buying stuff.” “Christmas is a pagan winter solstice festival co-opted by Christianity.”

      You figure out pretty quickly that “Christmas” is not something that exists independently of people's ideas and fantasies: there's no scientific test for Christmas (“ah, there are ten units of Christmas in the air today!”). On the contrary, Christmas is an idea; a thing that's real because a bunch of people have agreed to talk about it a certain way and accord it a certain structure (Christmas always has a tree and a snowman, even if the snowman is made of plastic).

      In this sense, bipolar disorder is a little like Christmas. It's an idea—an idea with lots of research and science and history backing it up (just like Christmas!) but also a construct dreamed up by our culture's medical system and influenced by very specific cultural values and assumptions. (Up until very recently in human history, they didn't have “bipolar” in Egypt or Samoa or Belize any more than they had “Christmas”—they are both ideas that got exported; interpretations of reality, not scientific facts.)

      So before we get into anything involving mania or depression or any of those things you expect to find in a book about bipolar, please review the following reminder: “Bipolar” is a word.

      It is a word psychiatrists made up so they would have a way to bill insurance companies. Insurance companies won't reimburse psychiatrists for treating suffering, but they will reimburse them for treating “bipolar.”

      It is a word psychiatrists made up because it is easier to give patients medication for “bipolar” than to say “you are suffering and I think this pill might help.” People in our culture are uncomfortable taking a pill because it will help them feel better (it feels like cheating), but we're OK with taking a pill if it's treating an identifiable and socially validated disease.

      It is a word psychiatrists made up because it would take too long at psychiatry conventions if everyone talked about “my patient who is really sad but also agitated and also can't sleep and also sleeps too much and also drinks too much and also can't quite hold down a job and is also a genius at painting and also had a terrible childhood”—it's more convenient to say “bipolar.”

      It is a word our culture uses because we're comfortable with medical problems, and definitely not comfortable with problems that imply there is anything wrong with our social and economic systems. It is easier to say, “You have bipolar!” than to say “The modern world demands people to be rigid and efficient, ambitious and desensitized, and if you are not those things, you're going to have a very hard time.”

      It is a word our culture uses because we are comfortable with medical problems, and definitely not comfortable with spiritual experiences. It is easier to say, “You are psychotic!” than to entertain the possibility that someone really did see God, or levitate, or have a profound insight into the Kabbalah, or whatever.

      This is not to say that bipolar is a meaningless word or an arbitrary word or a word some kooky psychiatrist cooked up just for the hell of it—but all words have limits, and when we're talking about a word as powerful as bipolar, it's essential to keep an eye on the context.

      “WHY ARE YOU HARPING ON THIS STUFF, YOU WIZENED OLD HAG?”

      Because it's true, and it's important. Yes, this book is going to talk about bipolar disorder in the “normal” sense (in the very next paragraph, in fact!) But if you don't understand the social and cultural context of this diagnosis, you're missing a whole lot.

      BIPOLAR? SAYS WHO?

      There are four things a psychiatrist takes into account before making a diagnosis of bipolar disorder: your current symptoms, your medical history, your family history, and your psychiatric history. Doctors see hundreds and hundreds of people and know what to look for. They look for patterns (“Wow, that guy talks in a constant stream without any pauses, and he hasn't slept for a week. And his uncle has bipolar, and he's taken four jobs”) that are consistent with what we're calling bipolar. You, of course, are a beautiful and unique snowflake, but like it or not, there are a number of classic behaviors and indicators (big and small) that people experiencing mania, hypomania, or depression in our culture tend to present. Quibble over details all you like, but if the shoe fits in five places, they're sticking that sucker on your foot. P.S. Hope you like Velcro.

      THINGS THAT GO INTO A BIPOLAR DIAGNOSIS

      1. CURRENT SYMPTOMS

      Do you seem depressed or manic? Have you mentioned being unable to sleep, unable to think straight, or crying all the time? Are you talking fast? Of course, you may feel that you are acting normally, but it can be very hard to reflect accurately on yourself especially if your symptoms have been creeping up on you over weeks or months. Over time, a psychiatrist will be able to compare your “manic” or “depressed” behaviors to your “baseline.” (For example, the psychiatrist might figure out that you always talk fast. It's just who you are, no big deal.) But for a first diagnosis, the only thing they can really compare you to is the general population.

      2. MEDICAL HISTORY

      Do СКАЧАТЬ