On being bipolar

The experience and politics of a common disorder

This week, something more personal. I am in the throes of a depressive episode resulting from bipolar disorder. It’s not very nice and I feel pretty awful, but at least I have learned that it’s not in fact my life that is causing my distress, but my disorder. So I wait it out. I experience these episodes every few weeks and they last a few days. I am writing this article in order to explain what it’s like, less for my own sake than for those who know or live with those who suffer from the disorder.

I was first diagnosed with bipolar about 15 years ago when I was living in New York. Until then, I had thought that regular and paralysing depression was a normal feature of life. During those pre-diagnosis depressions, my brain would freeze into what felt like a congealed lump of lead. Not only did I feel awful, but I became less capable of thought itself. Nothing felt worth doing. There was no point to anything. Even moving my body, starting with getting out of bed, felt like wading through concrete. I often thought of suicide, not as an intention, but more as a calculation. Was it worth staying alive? When I suffered these episodes while working at the UK Mission to the UN in the early 2000’s, I would stick post-it notes around my apartment before going to bed with messages to myself for the morning. ‘Keep going’ I wrote.

I honestly thought that this was normal. I thought everyone saw life as a constant calculation, a weighing up of the value of staying alive. Like filling in a debit-credit balance, almost literally. Happily, I always concluded that life was worth living, just about, or, later, that I could not abandon my family. Either that or that I lacked the courage to take my own life. I thought about the best method of suicide a lot. When I lived in an apartment in downtown Manhattan, my chosen method was jumping out of the high block we lived in, launching myself off the iron emergency staircase attached to the outside back wall. For some reason, I thought of that staircase often, sometimes almost constantly, like a kind of talisman accompanying my days, a way out should all else fail. I can vividly picture it now. This is known as suicidal ideation.

But it was the ‘high’ spells of the cycle that drove me to the psychiatrist, or rather drove my partner to insist I go to the psychiatrist. One of the frustrating things about memoirs or accounts of the experience of bipolar is that these authors often say that the ‘manic’ episodes are in some way ‘good’. They recount feeling grandiose, omnipotent, fecund; the episodes are sometimes characterised by irresponsible spending sprees, wild ambition or inventiveness, or promiscuity. Some say that after medication has ‘smoothed out’ their cycles that they ‘miss’ these manic episodes.

I don’t see my own ‘manic’ episodes as positive, at all. Instead, I would feel incredibly agitated and impatient, unable to sit within my own skin. I would also get very angry. I remember once screaming in rage on the ‘phone with (I’m glad to say not ‘at’) an unlucky colleague over some insignificant drama. On another occasion, I repeatedly slammed the receiver down on my office phone and smashed up the machine. I destroyed a crucial relationship with a major funder of the NGO I ran by ‘losing it’ during a meeting, literally banging the table and shouting. Because I was the boss, I didn’t get warned or fired. Walking along Bond Street in lower Manhattan, I once found myself punching the metal pillars of a scaffold. I’m glad to say I never was actually violent towards anyone else but I worried that one day I might be. I feared myself.

The psychiatrist was an almost Woody Allen cliché, a small, round Jewish shrink, who resembled Wallace Shawn, with an office in a basement on the Upper West Side who listened, diagnosed and prescribed. And he was, or rather the pills he gave me were, my salvation. Without him, or them, I would not be where I am today which is reasonably, though not perfectly, stable. I would certainly no longer be married. Very quickly, the pills controlled my manic episodes to the extent that I no longer experience them (mostly, at least). And I do not ‘miss’ those episodes, not one little bit.

My depressions too were lifted, mostly. No longer do I feel the leaden brain, the mental and almost physical paralysis, the fathomless despair for which you can find no plausible cause. Unfortunately, however, I do have occasional, and much shorter, episodes (like now), which serve as a reminder of what I once was. Before the pills, I was either depressed or manic, almost always one or the other, with only short periods of relative calm in between. And the cycles were getting worse, both the depression and the frantic agitation, both longer and deeper. In the grip of these ‘moods’ (though really they are much more and much worse than what we commonly understand as ‘moods’), I no longer felt myself at all. I felt mad (the English not American mad i.e. insane) and increasingly out of control. It took a considerable mental effort to appear normal, even if I was still mono-syllabic and anti-social.

And I’m still very much afraid of the condition. A close relation is bipolar. His life has been ruined by it. He was once a talented photographer who had girlfriends and a job as a teacher. His collapse over several decades has been gradual but inexorable. The photography stopped, the girlfriends fled and he was banned from his job. There were repeated, involuntary hospitalisations (‘sectioning’ as it’s known in the UK); earlier he had been forced to have electro convulsive therapy (ECT). None of it worked. Today, he lives as a total recluse in a small flat in Bradford. He barely speaks, resists all social contact and refuses medical treatment for physical ailments. I am going to see him tomorrow, in fact, for the first time in a long while (my siblings are much more frequent visitors). I have wondered why I have not visited him more, although I think of him often. The truth is that he makes me afraid, of what I might have become, or may yet.

He is colour blind and has bad knees, as do I. We look very similar and are the same height. My cousin too was colour blind and prone to depression and used too many ‘recreational’ drugs and too much alcohol. He took his own life a year or so ago. I don’t think he was ever diagnosed with bipolar, but I think it’s certainly possible he had it. The genetic inheritance is clear: like the colour blindness, the bipolar comes from my mother’s side of the family: it appears to be a recessive gene, only affecting the men in the family. Before he died, my cousin separated from his partner (she left him, in fact) and became more isolated. I tried to visit him, but he refused, saying he wasn’t ‘up to it’. I often thought of writing to share my experience of bipolar with him. I did not do so, to my deep and eternal regret. I felt I did not want to make assumptions or impose my own experience upon him. I think this was an awful misjudgement. And for those worried about friends or family members, the lesson is very clear.

My other, still living, relation was never successfully medicated either. He didn’t like his ‘meds’ and would frequently stop taking them, a choice that would often lead to wild manic bouts and more involuntary hospitalisations. By contrast, I feel lucky that after over ten years of trying different pills, combinations and doses, I have found a mix that more or less seems to work, a handful of pills I take several times a day, the ‘pill alarm’ a regular interruption to my day. My relative wealth helps too: I can afford a private psychiatrist, so I’m not forced to rely on the very, very infrequent appointments offered by the grossly-overburdened National Health Service (to no one’s surprise, there is a national mental health crisis).

But nevertheless my drugs have given me grim periods. A couple of years ago the manufacturer stopped making one of my pills. To this day, I find this almost unbelievable. It took several months before they resumed manufacture, with no explanation to the many thousands who depended on the drug. In the meantime, and now living in Wales, I went back to my New York psychiatrist who was willing to prescribe the drug on the basis of a phone consultation. His local pharmacy in New York would supply the pills but not mail them, requiring us to recruit friends or family willing to bring the many packets of pills across the Atlantic undeclared in their luggage, at risk to themselves if discovered.

I shudder to think what those without my privilege went through. When I occasionally forget the pills on a trip or when distracted, the effects, perhaps as much psychosomatic as actual, are immediate and awful. I also don’t love that I will be dependent on these pills for the rest of my life, dependent on my monthly visit to the local pharmacy, dependent on them having the correct pills, dependent on my GP to re-prescribe the drugs every few months, and of course paying for multiple prescriptions (in Wales, they are free!). Each week, on Saturday mornings, I sit down with a large tray of pill packets, counting them into a dispenser for my daily dose. Of course many people must do this, for a whole host of conditions, so there is nothing unusual in this experience. I just don’t like it. My sanity and wellbeing hang by a thread on that pile of pill-packets, carefully stashed in a wardrobe where visitors cannot see them. Covid was a scary period for me, but not because of Covid. If there’s a zombie apocalypse, I’m screwed, and not because of the zombies.

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I share this today because, on days when the depression strikes, there’s really not much else I’m capable of doing. Writing this article feels more constructive than what I would otherwise be doing: watching TikTok videos of Pink Floyd or synchronised dancing - at least a bit. But it’s also, oddly, because of the publication of my book. It’s a very personal book, though I do not talk about bipolar or one or two other family issues that preoccupy me. But precisely because it’s a reasonably intimate portrayal of me and my politics, it is also stripping away a particular persona that has served me well since I resigned from the Foreign Office (a departure which itself required the loss of an earlier, artificially-constructed persona).

I have become more and more fascinated by Jung, who argues that the escape from our false personae is necessary for us to become ‘integrated’ or whole, a process that often happens only later in life, a process that includes facing up to one’s darkness. Those personae may have served us well earlier in life by protecting us from pain, but the shedding of the mask of the persona leaves behind a self that, although more vulnerable, is more fully connected to the world, where the boundaries between self and the rest of life dissolve, and this is wonderful, really wonderful. But it also requires a transparency that earlier iterations of the persona avoided. And the product of this transparency is what you’re reading now.

And, as typical with me, I’m interested in the politics of this experience and this disorder. I don’t think it’s a coincidence, even if it is surprising, that I wrote the book during my darkest years when we were living in Wales (melancholia which I often humorously blame on the Welsh people, even though in reality it wasn’t their fault at all). There’s really nothing good about being bipolar, but I do think that somehow it helps me see the pattern in things and for these patterns occasionally to coagulate into more holistic syntheses (the ‘gestalt’ mentioned in the book, for instance), often unconsciously and in the concealed depths of a depressed brain that is otherwise incapable of consciously directed thought.

The disorder has also helped me understand the dangers of the false persona in separating us from others, indeed perhaps from ourselves. Capitalism, the current system, call it what you will, of course forces us to wear such masks, constantly. In my office, where I work in a ‘co-working’ space, I see it in the strained and artificially upbeat conversations in the lift among groups of thirty-somethings, one of whom is obviously the boss, the others sycophantic, overattentive and thus obviously subordinate. And I see it in the quiet moments of those very same people when they sit alone in the coffee lounge, pensive and noticeably downbeat not up. Such observations earlier helped stimulate my interest in anarchism, a political philosophy, perhaps the only one, that allows us at last to be our true selves, shorn of the fake personae that hierarchy inevitably forces upon us, freed from the invisible social barriers that so needlessly separate us.

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This condition has been a big secret in my life. Many of my friends and family have no idea that I go through this and, I suspect, will be rather shocked. I have been highly successful at ‘masking’. But I do think it’s important that people know. It is unfortunately a fairly common disorder and for the sufferers themselves, their families and friends or colleagues, it can be life destroying, sometimes most literally. Just as I should have written about it to my poor cousin, please don’t, if it’s mentioned to you, be one of those people who minimise or change the subject. My mother, for instance, has never asked me about it, though she knows about it (and she won’t be reading this!). I don’t judge, because I do the same about lots of awkward topics, but I do want to make this point.

Try to be more like my friend M. who, a few years ago, I met for lunch, when I was so depressed I could barely speak. Upon arriving at the restaurant, I immediately and rudely told him I wanted to leave. While gently persuading me to stay, and tolerating my ensuing silence, he acknowledged me and after our lunch sent me an email, not seeking to solve my problem but a simple and pure expression of affection, an act of compassion I shall never forget, an act I am still moved by every time I cycle past the restaurant where we met, a Chinese café near Tottenham Court Road. Bipolar may be the reason a colleague, friend or relation is bad tempered, ‘moody’ or uncommunicative, even obnoxious (I was!). At least allow for this possibility before judging them.

I dedicate this column to the young Portuguese woman who works at the reception in my office who yesterday simply asked me, how are you, and her eyes told me she really meant it. Somehow she had detected my distress, much as I thought I was successfully concealing it. It’s important that those around people with bipolar at least acknowledge their experience, perhaps simply by asking about it. You don’t have to be an expert to help. I don’t want to be overdramatic, but those questions and that acknowledgement might be the thing that saves them from death itself.

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