Interesting post at Furious Seasons recently (heh, as if there were not an interesting post there nearly every day!) regarding manic depression as a dangerous gift, as a personality disorder, and as something from which one can completely recover.

I know I am going out on a limb here that someone will likely chop off for me, but I believe that much of what we call bipolar disorder is in fact a personality disorder or constellation of behavioral issues.

I’m not looking to chop off this limb. I view manic depression as a dangerous gift as well, and as something that maybe at least some people can completely recover from. I also understand that Philip is not saying all a person with bipolar disorder has to do to recover is pull themselves up by their bootstraps:

I think bipolar disorder can be a personality disorder–and, nitpickers be warned, I am using the term very broadly–more often than it is a mental illness.

Depression–and here I am not discussing major or clinical depression–is widely known as having a huge personality component.

Mania itself–and here I mean the bad old wild delusions, hallucinations and declarations of Godhead mania–is not a personality disorder. When it’s in full flower, mania is straight-up insanity.

Dysphoric mania is possibly the least fun thing in the world, but there is at least one good thing about it: once you’ve recovered from an episode of psychotic dysphoric mania, it’s really hard to convince yourself that it was a character flaw. You can easily convince yourself that you weren’t depressed, just stupid and lazy, and that you weren’t hypomanic, you were just being a silly, reckless whore… but after having auditory hallucinations for a few weeks straight, once I finally stopped, I realized that something had been really wrong and that this time it wasn’t my fault.

I was aware that most of the time, medication either made me a zombie or made my moods even worse. So sometimes I would stop taking medication, be fine for a few months, and then be much, much worse than before. I learned to do things that sometimes stopped mood episodes, but more often just allowed me to cope with the symptoms I experienced, so that I functioned very well as one of the walking wounded. For quite a long time, I honestly believed that there was no such thing as getting better, there was only becoming a better liar, so that you could hide your pain from others and even from yourself. Or at least I thought that was the only option for me, because I’d read about other people who were asymptomatic for long periods of time, who claimed to experience “growth” and “healing.” I didn’t disbelieve them, but I didn’t think that anything would work for me. I tried CBT, DBT skills, family therapy, couples therapy, group therapy, exercise, meditation, hospitalization, acupuncture, journalling, medication, medication, medication, and other stuff… but the hits just kept coming. I kept getting depressed, I kept getting hypomanic, and I kept getting manic.

Some of those things helped. Some didn’t. (Acupuncture, for instance, was supposed to make me less stressed, but instead it turned me into a stressed person with needles in her ears.) For nearly a decade, though, none of them prevented me from having mood episodes, which I dealt with using a combined method of actual coping skills plus being way, way too hard on myself. I have been essentially non-syndromal for the past year, though, and it seems to be solely because I’m finally on medication that’s working for me.

I am better, and I want this to be an accomplishment. I wish this were something I could take credit for. But it’s not.

The journey to get to this point was so long and arduous that I want the current solution to be complex. (I say “current solution” because although this has been the solution for the past year, I don’t assume it will be the solution that works best for me forever.) It’s not complex, though. It’s not intricate. I-take-two-pills-a-day-and-now-I-am-well. If I am experiencing any side effects, I am not aware of them. I still have emotions. I can cry when really bad things happen, I can take joy in something as simple as seeing furry gray squirrels race across tree branches, and I can write really bad fiction.

Despite how hard I tried to get better, I still can’t take any responsibility for it. It’s true that I learned plenty of things along the way, including just how vast the extent of my own ignorance is (and how ignorant many of my doctors were), but nothing I learned was instrumental in my actual recovery. I tried and tried and tried to save myself, yet I did not.

I wish I’d fixed it. I know I should be careful what I wish for. I’ll say that I wish I’d slain the dragon myself and the next thing you know, the meds will poop out and the dragon will pop back up, all scaly and fire-breathing, saying, “You called? Here I am, bitch. Come and get me.”

But still. I wish I’d fixed it.

There’s a Wired article called Anakin Skywalker: Borderline Personality, Bipolar or Narcissist? that I found via stir-crazy, they found via Mind Hacks, and they found via Omni Brain. I’d especially recommend reading both the Wired story and the Mind Hacks post.

I only have a few comments to make:

1. Hee.
2. Hey, I’ve been told I have bipolar disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder, just like they’re saying about Anakin Skywalker. This can mean one thing, and one thing only: I AM DARTH VADER!
3. The article reminded me right away of a humorous article I’d read years ago in the Canadian Medical Association Journal, “Pathology in the Hundred Acre Wood: a neurodevelopmental perspective on A.A. Milne”, so I was extremely happy to see that the Wired story linked to it.

Admittedly, though, I don’t actually think I’m borderline, and I know I’m not histrionic or narcissistic.

According to the authors, who reported their findings at the American Psychiatric Association’s annual meeting in San Diego, Skywalker meets the criteria for the condition: He has difficulty controlling anger, stress-related breaks with reality (after women in his life die or leave), impulsivity (dangerous pod racing), obsession with abandonment (those women again) and a “pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of ideation and devaluation” (hello, Obi-Wan).

In another sign that he’s borderline, the authors argue that Skywalker suffers from an “identity disturbance.” After all, he did become Darth Vader after being “very unsure of who he was and what he wanted.”

I don’t have difficulty controlling anger, obsession with abandonment, an identity disturbance, or a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of ideation and devaluation. I am impulsive and have had stress-related breaks with reality. Well, I can live in hope that those two things are enough to MAKE ME DARTH VADER, can’t I?

What is the best treatment for one who has been drawn to the Dark Side of the Force? The opinions of professionals are mixed:

Study co-author Bui said psychotherapy — “long term,” he added with a laugh — would be the best treatment for Skywalker, although he might prescribe a drug to help him sleep.

Bui had mixed feelings about prescribing an antidepressant like Prozac and said he’d avoid tranquilizers like Xanax that could leave Skywalker addicted or send him into “disassociation” (a rupture with reality).

But would Skywalker even go into therapy? “Because of his narcissistic tendencies he would perceive himself as ‘above’ that,” said Sultanoff, who thinks Skywalker also suffers from narcissistic personality disorder, at least in Star Wars Episode II.

I’m going to assume that by “disassociation,” Randy Dotinga means “dissociation.”

Not that there’s much point in trying to help Anakin at this point. He’s dead, yo. Remember?

I have an appointment with a new psychiatrist tomorrow. I’m nervous about this. The last time I saw a psychiatrist was about eight months ago. He was a complete asshole who pronounced me borderline, histrionic, and narcissistic after watching through a two-way mirror as a medical student interviewed me for about forty minutes and only speaking briefly with me himself. (By the way, the last mental health professionals who had dealt with me, who saw me nearly every day for seven weeks, had said that I definitely do not have any personality disorders.)

When I asked him why he thought I probably had these three personality disorders, he said it was because I showed no emotion whatsoever and denied the fact that I even had emotions. This is patently untrue, as I am pretty much the exact opposite. (And although I also don’t have histrionic personality disorder, I’d still like to point out that “shows no emotions” certainly doesn’t describe a histrionic, either.) He said that he could tell I had personality disorders because I didn’t talk about my feelings, just about things like the dates that certain things happened to me, and about every medications I had ever taken and at what dosages. Um, the reason I was talking about those things was that I was answering the questions the med student asked me. I thought a lot of them were tedious myself and I would have preferred to talk about other things, so why the hell was he basing my diagnosis on his dislike of the student’s interviewing style?

He didn’t have access to my previous files, in which my diagnosis of bipolar disorder is confirmed by multiple doctors, but I’m sure it would have made no difference to him if he had.

He also said some other bizarre things, like that I should tell my mother that I hate her. I don’t hate her, so I don’t know what purpose that would serve, but when I asked him why I should tell her I hate her, all he would say was that I should tell her I hate her and he wouldn’t give me any actual reason. He said that it wouldn’t kill her or anything if I told her I hated her, and I said, “Yeah, I know that. I’ve gotten angry at my mother plenty of times and it didn’t kill her, but I don’t see why I should tell her I hate her when I don’t.”

Who died and made him Freud?

He said that the best thing for me would be “fairness focused therapy” or something like that. I don’t remember the exact term, but it involved the words “fairness” and “therapy.” I haven’t really done extensive searching on the topic, but I have tried doing some Google searches and some journal searches, and as of yet, I have seen nothing that would indicate that this particular type of therapy even exists, let alone that it would be the best treatment for me. He told me I should go to some “fairness” program at the hospital three times a week, and when I asked if it were possible for a person to attend that program and still hold down a job, he seemed to think this was a completely unimportant consideration, despite the fact that I was stable at the time and there was nothing else that would prevent me from working.

So I figured he could fuck off and die. I didn’t say that to him, though. I was polite and decided never to go back to that hospital again because whatever crazy shit he must have written about me in my chart would totally bias anybody there against me.

I am seeing a shrink elsewhere tomorrow, not at the hospital, but you can see why I’m nervous. At least I think I’m seeing a shrink. My GP referred me to a shrink and I’ve got an appointment at a mental health centre, but I don’t know if I actually get to see the shrink tomorrow or if I see a social worker first or what.

In addition to being mega-nervous about this appointment in general, I’m also worried about my recent eating-disordered behaviour. To the best of my knowledge, I’ve never been officially diagnosed with an eating disorder. This is mainly because I am — okay, I want to say “a big fat liar,” but that is so not appropriate here. Let’s just say that I’m a liar, okay? And a really good, sneaky, convincing one, as far as eating disorders are concerned. The other reason is that whenever I do come clean about my eating-disordered behaviour, it’s always about things I’ve done in the past and never anything I’m currently doing.

“Officially” diagnosed or not, however, in the past I have met full criteria for anorexia nervosa. This would have been in 2001, when I lost over 20% of my body weight, had a BMI of 15.2, and still managed to convince most people that I wasn’t doing it on purpose. I didn’t fool my mom, but I fooled everyone else. I started losing weight when I was in the hospital in December 2000, following my suicide attempt, because I was physically weak after the overdose and hospital food sucked, and after that I just kept losing weight on purpose, because starving yourself is a more socially acceptable form of self-injury than cutting, I was manic so it was easy to lose weight, and I think I had developed a weird addiction to it.

I’ve never been overweight. I’ve always been thin. I have the extreme good luck to not even gain any weight when on anticonvulsants and atypical antipsychotics. I do not think my appearance would be improved if I lost weight. I know it actually makes me look worse. Eating-disordered behaviour is purely a form of self-injury for me. Well, eating disorders have all sorts of complex causes, but I can assure you, mine has nothing to do with me wanting to look pretty. (I know a lot of other people’s don’t, either, but I know it is a factor in some people’s EDs.)

Anyway, I’ve been restricting my food intake way too much lately (and since I’m naturally thin, any time that I restrict my food intake at all instead of eating whatever I damn well please is a sign of disordered eating for me) and worrying about my weight. For about the past two months, I hadn’t been feeling as hungry as usual… so a few weeks ago, I just sort of took that fact and ran with it. The less I ate, the less I decided I should eat. Now I’m purposely restricting instead of just eating less because I haven’t been hungry. I know I’ve lost a bit of weight. I’ve been eating one meal a day, but now I’ve even started worrying about exactly what that one meal contains, counting calories and all of that.

It was in 2002 that I may have met full criteria for bulimia nervosa. Maybe not, though. I’m not sure I binged enough for that, but I sure as hell threw up a lot. Binged and threw up, ate normally and threw up, restricted and threw up. Most of the weight that I had lost previously, I gained back in late 2001, and then lost it again in 2002. Purged once or twice a day, got nosebleeds from throwing up so much. If your eating disorder is mainly a means of self-injury, then you love the immediacy of bulimia. Binge right now, then purge a few minutes later! Relief right now, or self-torture right now, or both, whichever you want, but right now! No waiting like there is when you’re starving yourself, instant results! It’s mercurial and intense and appeals to short attention spans.

I’m managing to stay away from it now, though. It might have even been years since I’ve purged. I’m tempted lately, but I’m not vomiting and I’m not taking laxatives (yeah, I did that, too, although mostly back in 1999). Maybe my self-control has gotten better. Heck, maybe it’s gotten a little bit too good, what with the restricting.

I have had food issues, mostly in an ED-NOS sort of way, on and off for at least eight years, probably longer. It never lasts very long. Never more than six months at a really serious level, anyway. It always goes away, but then it always comes back. Socially sanctioned self-destruction. Eating-disordered behaviour is always the last card I have up my sleeve when everything else is gone, and I keep playing it again and again and again.

And I’m getting fucking sick of it. I’d thought I was better, because it had been away for so long this time. I thought it wasn’t coming back. I thought it could just go away on its own without me working to fix it, because I thought it wasn’t really serious, you know, not like eating disorders that other people have. That other people have real problems and deserve real help and I don’t.

This time, I would kind of like to tell somebody about it so I can start working on this for the first time in my life and make some real progress on it. But I’m scared that people will think I’m just making a big deal out of nothing. So I’ve been on an unnecessary diet for a few weeks, so what? Haven’t most people been at one time or another? Don’t I have enough real issues to deal with, without getting all bent out of shape over this? I really am scared that no one will take me seriously if I ask for help with this.

Also, at the same time, I kind of don’t want to get better.

Just out of curiosity, I recently looked up information online about the nearest eating disorders clinic. It’s not really near at all and I know my problem isn’t severe enough that I’d need the programme there, but having been in a partial hospitalization programme last year, I just had an idle curiosity about such things. I noticed when I read the referral criteria that even if I wanted to participate in the programme, I couldn’t, because my current BMI is lower than the minimum allowed (they want participants to be at a healthy weight before they work on their psychological issues). This pleased me.

I am seriously sick in the head.