How Do You Define Yourself?

A friend asked me recently about my preoccupation with writing articles on my blog about Bipolar Disorder. Was I defining myself based on a pathology and medical term that a doctor recently assigned to me to the exclusion of all the other varied parts of who I am? My answer is both no and maybe. Always best to be unequivocal.

In the past, I’ve largely defined myself based on my academic and work accomplishments. I earned a Ph.D. in Educational Psychology with a focus on cognition and learning, and I’ve worked as a manager at one of the most prestigious software companies in the world. I’ve published articles and book chapters and I’ve traveled to conferences and presented research papers in several countries. Besides that, I also started and managed a commercial construction company with my husband for 28 years. I’m high functioning and very thankful that I’m able to do what I do. I’ve had many blessings and great good fortune in my academic and work careers. Great people to work with and a few excellent managers. Work has been a large part of my life and one very important way that I’ve defined myself. However, after my last manic episode, I’ve not felt stable enough to go back to work and so redefining myself has been traumatically difficult. But it has to happen.

I also have wonderful friends and a great family. Overall, I define myself as a healthy person who enjoys life and who has enthusiasm for living and learning new things. A lifelong learner with a zest for exploring, meeting new people, and sharing ideas and experiences with others. That zest and enthusiasm is especially easy to conjure up when I’m hypomanic. Not so easy when I’m medicated and level. It’s impossible when I’m depressed.

But I’ve learned some hard lessons in the last few years, and I don’t want to repeat them. Right now, I’m focused on understanding what happened. I tend to be intense and a bit obsessive, so digging in and learning everything that I can about Bipolar Disorder makes sense to me.

A couple of years ago, during my last six months working at the software company, it became clear to me that I could no longer manage my moods without help. It wasn’t until after I quit my job and retired, that I went to a doctor for help and he prescribed lithium. I took one very low dose pill that night and the next morning, I felt amazingly good again. Clear thinking, happy, but not too happy (not over the top). The difference was startling. At that time, I was convinced that it was just a coincidence, and that I didn’t have a REAL mood disorder. Denial is a common reaction to hearing unpleasant news or receiving information about yourself that you don’t want to be true.

I’ve taken a small dose of lithium for a year and a half now. Prior to that time, I’d always been able to manage my moods well enough to get by, and I was able to avoid participating in activities that created total chaos. Perhaps that’s because I worked so many hours and didn’t have much time to get into trouble. That sounds facetious, but I’m partially serious. People finds ways to cope in life, and being a workaholic is highly rewarded in this culture.

Make no mistake about it though, I did have severe mood swings, mostly hypomania, and I poured most of that energy into my work. Sometimes the mood swings got the better of me, but I always bounced back quickly. Until two years ago, when I believed that the only option open to me at that time was to quit my job and retire early. In hindsight, that was a poor decision made when I was beginning to crash hard after going through an extended (two year) hypomanic episode. But alas, hindsight being what it is, isn’t worth much except maybe to help you avoid making the same mistake twice.

Fast forward a year. After a year on lithium, I thought, well dang, I feel so good, I don’t need this medication and I cut it way back. Back to only 100 mg a day. Not even a clinically relevant dose. That’s when all hell broke loose. Thank goodness I stayed on at least that small dose that summer. At that time, I’d been diagnosed with a mild mood disorder but not Bipolar Disorder. I didn’t take it seriously and just went on about my life. Life grabbed me hard and knocked me to my knees in 2009. I’m standing on my feet again, healing now, and trying to make sense of what happened.

I know now that I do have a relatively mild case of Bipolar Disorder 1, and being who I am, I want to learn everything about it so that I can manage it and live a full, creative, and rich life. I’m lucky because I can do that. So many people who suffer from Bipolar Disorder have a very severe form and even with medication and therapy find themselves cycling into extreme mood swings that devastate their lives and the lives of those they love on a fairly regular basis. I don’t want to find myself in that position. The kindling model of Bipolar Disorder is intriguing and makes me want to put as much effort as needed into avoiding further episodes. I know that is unlikely and not realistic, but I can certainly do what I can to minimize the extremes when episodes do occur. Demitri and Janice Papolos, describe the kindling model as follows:

” … initial periods of cycling may begin with an environmental stressor, but if the cycles continue or occur unchecked, the brain becomes kindled or sensitized … – and future episodes of depression, hypomania, or mania will occur by themselves with greater and greater frequency.

Thus, to put it simply, brain cells that have been involved in an episode once are more likely to do so again, and more cells will become sensitized over time. This theory has been borne out by some research observations. For example, “there is evidence that the more mood episodes a person has, the harder it is to treat each subsequent episode…” thus taking the kindling analogy one step further: that a fire which has spread is harder to put out (Expert Consensus, 1997).” The kindling theory makes it very hard to ignore the need to monitor and manage moods if you have Bipolar Disorder.

The answer to the question, ” Does Bipolar Disorder define who I am?” is both no and maybe. No, not at this point in my life because I’m working hard to understand and manage it. Maybe is my second answer. Maybe it will, but only if I fail to manage it properly and allow it to control me, and I don’t plan on ever letting that happen.

What about you? How do you define yourself? What do you do to ensure that your feelings, moods, and behaviors represent and define the best parts of who you are?