I am a psychiatrist with a practice in New York City and I have bipolar disorder. My story is about the voices in my head.
For years, my bipolar closet door remained firmly shut. I think we all have such doors where we keep things that are painful, overwhelming, disturbing, and shameful. I was living in a castle with the drawbridge pulled up, wandering around by myself behind impregnable walls. Although I had been treating patients with depression and bipolar disorder for years, it had never occurred to me that I, too, was ill.
When I finally allowed myself to recognize this, I viewed myself as weak and pathological. My depressive periods would typically last a few months. It was a very physical illness for me, making me feel empty inside. Every aspect of my internal and external world seemed permanently dead. Although these periods were painful, my hypomanic periods caused me much more distress and have had profound consequences for me. When hypomanic, my brain is hijacked, taken over by a flood of neurotransmitters that transport me to places I haven’t asked to go. I have thoughts I’d never have in my right mind, propelled into actions that my sane self would never do. It’s like being taken, against my will, to a place of insanity where I lose my moral compass. No amount of effort, no amount of will, no amount of wishing or praying will stop this from happening, and it is deeply disturbing to be forced to surrender in this way.
And sex. I’m insatiable in my libidinous appetite. Although I am showing up for work and functioning every day when hypomanic, I am actually on fire. With the grossly impaired judgment that accompanied my hypomanic state, I was catapulted forward with severe consequences causing me to ask soul-searching questions. How can I ever forgive myself? How can I reconcile the guy who values decency, fidelity, health, and safety with the guy who has behaved contrary to all those basic traits? Will it ever be possible to reclaim my soul?
My journey toward acceptance and reconciliation began with the recognition that my health and safety, my marriage, and my career, were all at risk. I could no longer keep my bipolar closet door sealed shut. I began to wonder what healing might look like, and realized that I had to begin with the voices in my head. These voices give rise to two story lines: one true, one not. For me, there had been a loud and persistent shame narrative telling me that I was weak, sick, worthy of blame and contempt, cowardly, and immoral. This narrative was harsh, cruel, unfair and untrue.
I believe that shame only survives in the dark. When we secret our truth away, when we are silent, we are confirming that we are worthy of shame. But what remains unspoken eventually becomes unspeakable. I have to claim a different narrative, one that is actually true. If I were treating a patient who told me a story like mine, what would I say? I think I’d be impressed that they had the bravery and strength to share it with me, and feel that they deserve understanding, kindness, respect, and decency. Rather than viewing them as weak, I’d see them as scared; rather than cowardly, as having taken missteps; rather than worthy of contempt, as being vulnerable. The conclusion I would draw, quite simply, is that they are human.
This narrative is both undeniable and freeing. So, can we step forward, find our voices, tell our stories, and reclaim our healthy narratives? Can we listen to kind, fair, reasonable, understanding, and decent voices in our heads?
These days, I am more persistent than the condemning voices, but I recognize that healing requires an ongoing effort. If we can just find our way to that fair and decent place, it’s easier to find our way back when we are inevitably pulled toward secrecy and shame. If a blind man is given sight for a day and then becomes blind again, what he saw can’t be unseen. Nor can we un-feel what we have felt.
I know that life can still sometimes carry me to places I’d rather not go. I now know that I hold no sway over my brain’s un-medicated neurotransmitters and the behaviors that occur when they rage. But my efforts to move in the direction of ownership, to come out of the shadows and embrace my story with compassion and respect, help me find solid footing. I’m trying hard not to be cut off from my internal emotional world and hide in the darkness. I’m no longer immersed in shame, living in silence behind castle walls. I’m telling my story and reclaiming my healthy narrative—and, in so doing, am both a care giver and a care receiver.