Bipolar disorder and work

Introduction

In 2012 I was off work for nine weeks with Bipolar disorder. There has been a lot about this in the news and I strongly support the work of the Time to Change and Stand to Reason campaigns which encourage people to be open about mental illness.

I have written on the subject in my church magazine and I have started a group at my church to respond to the campaign by trying to ensure that the church is a place where people who have experienced mental health problems feel welcomed, supported, and fully integrated at all levels of church life. However it strikes me that I have never written about it on my professional librarian's blog.

The effects of my illness at work

One reason, I'm glad to say, is that, apart from being off for nine weeks and the last day I was at work, my bipolar disorder has had very little impact at all on my working life, and I think that is something that needs saying for a start, because people with mental problems often find it very difficult to find work, and those of us who were quite happily doing our jobs need to get the message out there that, for better or worse, we are examples of how this can be done successfully.

Still, I can hear you saying, nine weeks is a long time. Well, that is true. In fact, my doctor recommended that I stay off work for four weeks, and it was my employers who told me not to come back because they were having problems liaising with the occupational health department during August and wanted to be sure that they had the right support mechanisms in place before I returned. Four weeks is still a long time, it's true, but many of my colleagues have had a lot of time off having children, coping with back problems, with broken legs and other things that happen from time to time.

How my illness started

I showed some signs of bipolar disorder thirteen years ago. It's difficult to find the words to describe what happened because in some ways it is quite personal, but, basically, I was quite lonely and isolated as a housewife with small children and I needed to 'get a life', which manifested itself in my falling in love with someone. Since I was already married and love my husband very much, this was a problem. [Never mention your husband in a work related blog or an interview: that's another one of my rules out of the window for starters.] I stopped eating or sleeping for a month. If you hardly sleep for a month your brain goes a bit funny: my brain went a bit funny, but not necessarily in a bad way. One morning I woke up with severe stomach pains and I knew it was time to go to the doctors.

The next bit is really not something I would normally put on a professional blog, so please bear with me here. I am quite religious and, after not sleeping or eating much for a month I ;started making unusual connections between things and seeing deep meanings in everything and believing I was experiencing some sort of prophecies. Some churches I knew perceived prophecies left, right, and centre, but that was not the sort of church I went to, so I realised that my thinking had changed quite a lot. My doctor said I was experiencing a hypermanic episode.

The thing is, during a hypermanic episode, your brain works very fast, you see colours far more vibrantly, you can speak much faster, and in some ways you function better than normally: the connections that I was making were very meaningful to me. They say that when the brain gets ill, the one thing it cannot judge is itself, so you do not think you are ill at all, but rather that you are functioning better than normal. For a long time afterwards, and even now, I was not sure if the religious experiences that I had during my 'hypermanic episode' were things that came from God or not (I do believe in God, I should mention here. Never mentioned that before either in my blog. How remiss of me.)

How my life changed

My doctor diagnosed me some pills (chloropromazine, tamazipan,) for three months and I went for counselling with a psychiatric nurse, at my local doctors' surgery for some time (six months I think or maybe six weeks, or maybe a year, it was ages ago, I forget.) I will always be grateful to him for his kindness. He treated me as if I was the crown jewels. He had just been reading a book on how to handle people with religious interpretations of their illnesses, which seemed like a wonderful co-incidence (but when you are ill you notice that those sort of 'co-incidences' happen all the time and that the world is a much stranger place than we normally perceive. - I recommend you read Stuart Sutherland's 'Irrationality' on the subject of statistical clustering and perception.)

Soon I was sleeping again, and sorting out my life. I was quite embarrassed by some of the things I'd said to the person I'd got a bit besotted with, but I got over my embarassment and the things I'd discovered during my period of questioning became integrated into my personality. I switched churches to one which was less dogmatic and suited my personality more and where I could sing in the choir, which was one of the things I aspired to.

I got a job as a volunteer in a library, then got a job as a peak relief assistant, then took a Masters degree in Librarianship and became a librarian. I worked in several libraries and eventually was very glad to get a job in Cambridge. I will always be grateful to the people who gave me that job, (and others who employed me,) and also to my current colleagues at my library who are such a joy to work with.

 

Making sense of what had happened

My psychiatrist told me that hypermanic episodes almost always reoccur, but I did not really believe him. I thought my case was different, partly because I felt protected by my faith and my family, but also because I had never fully accepted the medical narrative as a particularly helpful way to describe what happened to me. He was quite keen that I take chloropromazine permanently. I was pretty keen that I did not.

After my first hypermanic episode I lived a 'normal' life for thirteen years. What is a 'normal' life, I asked myself: had I always been a person with bipolar disorder? Was I a person with bipolar disorder? I often got quite fed up. Did that mean I was depressed? I often didn't feel anything very much. Sometimes I felt really happy. I think I am pretty 'normal.' My psychiatric nurse had asked me, at every visit "have you considered suicide." No, I never considered suicide. So basically, I think I am pretty normal and I have lived a pretty normal life.

 

Why I got ill again

During this period I was supported at first by the person with whom I had 'fallen in love' who was someone I had known since I was sixteen who lived many miles away. I became quite obsessed with this person and wrote him lots of letters. After a bit he thought I was becoming too dependent on him and he tried to draw away from me. Finally this year he made it clear to me that he wanted to end all contact with me.  My grandmother had died recently and the cracks that developed in my [wider] family exposed deep flaws.  At the same time I had to prepare for my children all leaving home.

At that point I 'lost it' a bit, stopped sleeping again, didn't eat much and started mildly harassing a different person. As before, after I stopped sleeping, my brain went funny again. I started thinking a strange and religious way again, but this time I was integrated into a church that I trusted (St. Mary's, Saffron Walden); it was all a bit close to home. I started making loud comments during church activities (i.e. even louder and less appropriate than normal.)

At work one day, having not slept the night before, I realised that I was not thinking clearly and that I needed to go home to see a doctor. If you can't sleep you shouldn't drive, for one thing. I explained to the doctor that I had been experiencing the 'prophet' way of thinking again. Naturally I did not mention this to anyone at work: I had not lost my sense of what was appropriate to say to whom (but I am mentioning it now- does that mean I am getting ill again?- these are the sort of things I have to consider.)

The thinking that I was interpreting as 'prophecies' this time were more obviously batty and wrong than the ideas I had had the first time. Did that mean that the life and belief changes I had made as a result of the first 'hypermanic' period had been wrong? Had I been 'mad' for thirteen years? Had I been 'mad' my whole life? Would people distrust me? Did I trust myself? Had my behaviour betrayed my friends' trust? It was all confusing and exhausting; I did seem to have fallen out with a suspiciously high number of nice people over the years. Perhaps I really am quite a difficult person? After a while I stopped worrying about it all and decided to divert all my energy into playing the euphonium, which is an exciting new challenge.

Looking to the future

I was referred to the same psychiatrist I'd seen thirteen years before. Drugs had come on a bit since then; now he recommended a different antipsychotic drug for a while and then lithium long term. I took the short term drugs (on and off. I did try!) But I did not want to take lithium long term. My psychiatrist says that if you take drugs it can reduce the likeliness of recurrence, or I could choose not to take the drugs and to take the risk of recurrence. We agreed that I should keep stocks of my pills to hand and take them if I felt I was getting ill again.

I am glad that I have not been taking medicines over the past thirteen years and I have chosen not to take drugs long term;and I still believe that my circumstances are special and that my illness will not reoccur (but remember, everyone thinks that.) I am still not entirely happy with the way that psychiatry describes the experiences that I went through, although I accept that their treatment is evidence-based and helps suicide prevention, which is very important.


I am quite a shy person and I was acutely embarassed by having inappropriately approached the two people mentioned. In some ways I had exhibited the behaviour of a stalker, which I found very difficult to live with, since stalkers are people I particularly despised.  The acute embarassment, which was one reason why I could not sleep, was perhaps the worst experience that I have ever had to live with (but then I have lived a very blessed and sheltered life.) There was no-where to hide or flee to: the people I had embarassed myself with were my own community where I had invested a lot of energy and emotions for years in becoming securely integrated and there was no real question of fleeing elsewhere this time.  These feelings of embarassment (and sometimes a sort of moderately sensible paranoia) were very extreme, physical manifestations and represent the 'down' side of the bipolar disorder.

Apart from that I feel like a bit of a mental health fraud because from my point of view I was only 'ill' for two periods of a few weeks, thirteen years apart from each other.

I see myself as at the fringe of the mental health spectrum: mostly I think I live a normal life and am perfectly healthy. The fact that my psychiatrist might disagree, if I went to see him, and wants to put me on drugs for the rest of my life, says more about the state of modern psychiatry than it does about me, in my opinion, but to act against the of teachings of modern medical thinking is not an action to be undertaken lightly. I am very grateful to my psychiatrist, who dealt with me very sensitively and had to handle my ambiguousness attitude and act as my pilot through the rough seas of the psychiatric world. I do appreciate that psychiatrists probably spend their lives dealing with people with far more severe problems than mine, and that their methods are quite possibly far more appropriate in those circumstances. And the fact that I have been dealt with so wisely and gently by all involved, including my psychiatrist, on both occassions has probably prevented what could have been a much worse and more long term experience of illness.

Why I have a streak in my hair

I stayed embarrassed until Christmas and I told myself that I would mourn until then and then I would forgive myself  - most of the other people involved had forgiven me long before that, especially my husband who always supports me whateverI do, and I do not take that lightly. Is 'forgiven' the right word here? I'm not sure. To mark the changes that happened to me I have had a white streak put in my hair; For me, my hair marks my identification with the community of those who suffer mental health problems: it marks my pain and my embarassment. My hair is embarrased for me so that I don't have to be any more.

As with my mental illness, people don't quite know what to make of it. My mother naivelly told me she liked my smart new elegant hair; some of my friends frankly implied that they thought it was in quite bad taste (we need friends like this!). My daughter told me that she likes it, and I respect her taste. I think she has the final word. I will keep it for a bit, I think. I am very grateful to my family for all their patience and kindness to me and for the times when I have been difficult to live with or preoccupied. They are very wonderful people.

Blogs are supposed to be spaces where work and the personal blend seamlessly: we work better with each other when we realise that each of us is human, and our faults are part of what makes us who we are. We need to stop pretending that good marriages are the same as easy marriages, we need to stop pretending that we are all superhuman: we need to treasure each other for the flaws that make us beautiful and specialised.