What piece of work is a bipolar? Okay, not exactly Shakespeare, but that is the question. Let's consider seven bipolars in my life: two of them are friends from New Jersey, two friends from California, one is recently deceased, one a past romantic relationship, another a present one. Plus myself, which makes eight. For privacy reasons, I will mix up the order and not reveal who is who.
The individuals represent a vast range of backgrounds, qualifications, and interests. One has a pair of professional degrees from two different Ivy League institutions, another is a high school graduate pumping gas. One grew up on a farm, another perks up in the hustle and bustle of Manhattan. Most are creatively or culturally gifted, some are relative philistines, and at least one manages to combine strong elements of both. Most have religious or spiritual inclinations, but there is at least one atheist. One, until fairly recently, was an elite marathon runner, while at least two are inexcusably negligent with regard to their physical health. On and on it goes.
All of us have a lot more going on in our lives than just bipolar. For the purpose of simplicity, we'll reduce it to just one other thing, thus:
Bipolar plus anxiety issues, bipolar plus alcohol and substance use, bipolar plus psychosis, bipolar plus borderline personality disorder, bipolar plus PTSD, bipolar plus ADD, bipolar plus past abuse, bipolar plus personal insecurities.
None of us has a monopoly on any of the "plus" concerns. Anxiety and attention deficits seem to go with the territory, whether as fully-fledged diagnoses or not. Excessive alcohol and drug use has been a concern with a number of individuals, and past abuse looms large. And, of course, we all have personal issues. On top of that, sleep is the great destroyer. But let's keep it simple:
Bipolar plus Anxiety Dude: This individual lives comfortably within his mood cycles. Indeed, bipolar is no longer his biggest concern. But he does have a tendency to over-think, which causes him to panic, which places him at extreme risk of flipping out. In stressful conditions that play to his strengths, he is as cool as a cucumber, which makes him successful in running his own business. But subject him to the wrong type of stress, and you are looking at the least stable and most incompetent person on the planet.
Bipolar plus Borderline Gal: An enormously talented and personable woman, she may find herself in a situation where she is enjoying herself in the company of others. Suddenly, she wonders if she has double-locked the door to her apartment. What if her cat picks the other lock? she starts thinking. Suddenly, she needs to leave. But a nice man is talking to her and won't stop. Next thing, out of nowhere, she explodes, lays into him. People stare. Suddenly, the world is very threatening. Two days later, she checks into a hospital.
Bipolar plus Alcohol and Substance Use Dude: Just when this individual seems to be getting his life on track, something stressful comes up. Next thing, he's reaching for something to help him cope. Next thing, he's picking up the pieces. Reaction to stress? An insatiable craving? Self-medicating from the bipolar? Perhaps all of the above.
Bipolar plus PTSD Gal: This individual was on the cusp of realizing her career dream when her brain got mugged. First, a horrific personal tragedy, then her home was destroyed in a fire. Pow! A one-two punch. Suddenly, she was reduced to nothing. Years later, she is back on track to achieving her dream, thanks to a lot of hard work, but part of the reason was that she was smart enough to realize that her exuberant personality was perhaps her greatest asset. Thankfully, she was not about to let any doctor medicate that out of her in the name of stability or relapse-prevention.
Bipolar plus Psychosis Dude: The range of this individual's intellectual interests is breath-taking, but he is prone to being blindsided by psychosis. Serious psychosis, 911 psychosis. Thus, he needs to be on an antipsychotic, and the side effects are crippling. His medication keeps the psychosis at bay, which keeps him off the streets and out of the criminal justice system. But it also slows his brain to the point that a probationary half-life seems to be the best he can hope for, though he's not about to settle for that.
Bipolar and ADD Dude: If this individual could figure a way to take his ubiquitous laptop into the swimming pool - while eating lasagna and reading a book and having sex and channel-surfing with the radio on and three phone conversations going - he would. Single-tasking is not in his vocabulary. Neither is time-management nor prioritizing. Often, he will miss a vital deadline or appointment because he got bogged down in something inconsequential, such as planting a forest and watching it grow. A subtle form of mania may drive his hyperkinetic multi-tasking, but ADD is what makes it work, and he has the successful life to prove it. But his ironic gift may one day lead to his fall from grace, and then he will have a lot to be depressed about.
Bipolar and Abuse Gal: The terrible things that life threw at this individual in childhood set her up as a sitting duck in adulthood. She is very smart in her meds and lifestyle strategies, but there is no quick fix for her bad memories and what they do to her. The good news is that she recently got married, relocated to a healing rural locale not far from the nation's capital, and is likely to find a position commensurate with her considerable qualifications and education.
Bipolar and Insecurities Dude: He came from a broken home with a crazy mom. He never had a higher education. His marriage and finances were in constant crisis. Who knows what insecurities he was hiding beneath his hugely charismatic and caring personality? We will never find out. Despite his infinite faith in God, one miserable muggy Sunday morning he lost faith in himself. His family and friends are still reeling from the loss.
"What a piece of work is a man, how noble in reason, how infinite in faculties, in form and moving how express and admirable, in action how like an angel, in apprehension how like a god! the beauty of the world, the paragon of animals - and yet, to me, what is this quintessence of dust?"
Hamlet never figured it out, and chances are neither will your psychiatrist or therapist, not in the course of rushed interviews occurring once in a blue moon. I have no doubt that bipolar is a valid diagnosis, but "Bipolar plus Me" far better describes what is holding me back, as well as what I have to be thankful for. Psychiatry and psychology provide us with invaluable insights into probing the "plus me" parts of our nature, but its practitioners largely abdicate the job to us.
We may all share the same diagnosis, but obviously we're not all the same. Addressing your bipolar is only the beginning. Successfully figuring out the rest - that's a huge plus.