Love on lithium

Facing a situation takes time, it means training our attention gently on whatever it is that's happening.

Facing a situation takes time, it means training our attention gently on whatever it is that's happening.

Published Dec 28, 2015

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Washington - On the top bunk I woke early, thinking of weddings: the one where we met, the one I saw in our future.

Thoughts raced to whether our kids would have her blue eyes, or my brown. But feeling in love with everything made it hard to tell how I felt about her. “The difficulty is the usual one,” as Virginia Woolf once wrote, “How to adjust the two worlds. It's no good getting violently excited: one must combine.”

Sarah and I had met at my cousin's wedding a year before, but she was dating someone. I'd told anyone who would listen: “The minute that girl gets single, you've got to tell me.” Now she was, and we were guests of my cousin and his wife at their cabin in Maine. This was my chance, and I was scared to fail.

The day before, we had cracked lobsters by the ocean. The birdlike energy swelled, making me flirty, fast; less able to hold my tongue. As the others dug pink meat from red claws, I tried to stop talking. But back in New York, I'd left behind an orange bottle of purple pills.

We were taking our first walk down the beach, having the talk that starts a new relationship. As we explored each other's pasts, picturing possible futures, I caught a whiff of doubt.

Her roommate, a psych student, had told her that I reminded her of that other guy, the ex-boyfriend who ended up crazy: anxious, angry, drunk and lost. Dropped out of grad school, checked into rehab.

We sat watching a sea gull, then rose to follow a trail through the woods, as I told her I thought her ex would get better. His illness isn't all he is, I'd said.

Later, remembering that conversation, I felt the familiar dread. Then the warm gush of hope that all might be okay.

What I've got is not curable and it runs in families. If you choose me, it might run in ours. So the question becomes: When do I tell her? Wait too long, and I'll risk coming off as secretive. Too soon, and she may get scared away. Once she gets attached to my better qualities, she may be willing to overlook the inconsistent attention, or what a bipolar friend calls the “relentless thump” of manic speech. But not yet.

We all have our secrets. Mine are the purple pills. Lithium carbonate, the simple salt, reins in the “psychotic excitement” of mania, as the Australian psychiatrist John Cade found in 1949. Scientists are still struggling to understand how lithium works, but we know for sure that it often does. As one researcher tells audiences: “Every person in this room knows someone with bipolar disorder. If you don't think you do, it's because they are on lithium.”

Once in high school, when my best friend called to make plans, I talked nonstop about honeybee communication until he cut me off, saying: “I'd rather watch my house burn down than listen to you speak another word.”

Among my friends and family, that combination of excitable energy and persistent enthusiasm, a bit absent-minded, longwinded, or oblivious, is who I am. What I lack in terseness or linearity, I make up for in openness, curiosity and drive.

Certain women, I've found, are drawn to these traits, too. But there is always the struggle to sort out the real from the wishful. Mania feels like love, but isn't: it's indiscriminate. Strong mood, the drive to find a perfect love or muse, threatens to blur the real partner into fantasy: like a fairy met on a psychedelic trip, or in a dream.

One weekend a year ago, Sarah invited me to Boston to meet her friends at a summer picnic in her backyard. After dating for a month, I was still hiding the pills. I'd taken lithium that morning, and was fully myself: alert and engaged, not too intense.

The picnic conversation at one point turned to gossip about a professor who was allegedly into child porn: a laptop he used in class showed an explicit term in the search history. What flipped a switch in my skull was not what people were saying, but rather, the tone of smug moral certainty I imagined I saw in the attitudes of these attractive, young educated people.

What if the professor never searched for the porn term, I found myself saying, but this was a common search for Internet trolls worldwide? What if the laptop wasn't his? Besides, paedophilia is illness, not evil, I said: If this guy is turned on by children, he should get treated, not punished.

I felt the familiar thrill of social conflict: a clash of ideas to be navigated. The ebb and flow of excitement, the rhythmic jolts of limbic pleasure like a suspenseful mystery with an uncertain ending, or erotic foreplay. The rise and fall of arousal, aliveness - isn't this what everybody lives for? It's a reminder that we are present, with hot blood throbbing in our veins, passions raw, all of us feeling the presence of now, together?

I knew immediately by the looks on people's faces, though, that I'd gotten carried away. Argument was not what these people signed up for on this pleasant afternoon. Fighting wasn't most people's idea of fun.

Later that night, a poem came to mind. TS Eliot wrote of J. Alfred Prufrock, “No! I am not Prince Hamlet, nor was meant to be, Am an attendant lord, one that will do to swell a progress, start a scene or two.”

I've often felt, this way, awaking to realise my role in the world is not what I thought: “Full of high sentence, but a bit obtuse; at times, indeed, almost ridiculous - Almost, at times, the Fool.”

What Sarah recalls most about that episode is that I wouldn't let it rest. The next day, sure that her roommate hated me and that I was a self-absorbed narcissist who had ruined the party for everyone, I made us rehash the conversation for two hours. But like the storms that arise after the honeymoon period of any new couple, this one somehow blew past.

Manic depression has a dark reputation, informed often by clichés more than experience. “Insanity porn,” as I call the cartoon of madness in the media, is titillating and dramatic; but not realistic - at least not comprehensive. Coming out stories, in books, TV, and movies, written by bipolar authors, also often emphasise these moments, presumably to make bipolar readers feel less alone. I recognise myself in such memoirs: the two years of unstable mood in my mid-twenties, painful to my loved ones and myself. The lurid week in a mental hospital that makes for such a dramatically macabre opener; the six months at my parents' house at age 27, feeling like a failure and a broken person.

The goal of highlighting such episodes, I assume, is to persuade people that bipolar disorder is not our fault, but a serious medical illness. Stories that emphasise these medical dark sides, though, often reinforce stigma, more than erode it.

If the woman you're dating hears “bipolar disorder” and imagines suicide and the mental ward - a place where many of us have been, yes, but often for just a week, before getting treatment - then she is more likely to feel wariness and pity than empathy. Not the feelings you want from the woman you'd like to share a bed with, or a lifetime.

Manic depression is a serious condition. If untreated, a bipolar person is thirteen times more likely to kill himself: suicide is the number one cause of premature death in bipolar people. Brain scans show shrunken regions responsible for controlling mood; thinner white matter bridges; and altered neural activity in the bipolar brain. Bipolar is around 85 percent heritable, more than breast cancer, diabetes and heart disease. My own premature birth increased the chance that I would develop bipolar by seven times.

So bipolar disorder remains a scary red flag in the popular imagination. But in fact, bipolar people are often high functioning. On lithium, many patients do not relapse for ten years or more. Tempered by lithium, the intensity of the bipolar temperament is often less a flaw than a gift. Living with a mood disorder forces you to mind your emotions, as a ship's captain does his compass: you become a meteorologist of your own moods..

If I lose sleep, forget to take lithium, or run low when travelling, I act on feelings. I see rationally that I have no reason to feel so elated, so afraid, or so quickly in love-again, with a woman I just met. She may be beautiful, yes, and smart. We probably did have chemistry at that wedding. But it is not normal to feel so strongly about someone you just met. I coach myself: “Breathe. Shut up. Don't propose.”

My feeling for Sarah was not just the fiction of mania and three months after Maine, I told her about me.

We were house sitting in New Haven that weekend, midway between New York and Boston. Things had been going well with us, as we alternated weekend visits. We'd take long runs along the Charles, write the giddy long messages new couples do, full of links to articles and songs. I'd awake in her bed singing.

We were at a pizza place in New Haven at the end of our lunch. I'd been gushing about a bebop musician, in a branching, flowing riff, when Sarah blurted out: “I've been meaning to ask: are you bipolar?”

I suggested we take a walk around the green.

On the grass near Yale's campus, I told her about the change that hit me at 25, in St. Louis, and what it felt like to lose a self. Too restless to read, too sad to sleep, I'd stare at a wall for three hours straight. Parties scared me. If someone asked “What do you like to do?,” I wouldn't have an answer. I could not remember what it felt like to care. I told her what followed: the flood of words, want, ambition; emails of lust and rage. I told her about the hospital, and the drug that brought back the me that was gone.

The realisation had been dawning for a while, Sarah told me. The fast talk, the weird sleep, the sudden urgency about a book, a song, a person. She'd noticed how many of my heroes in writing and music had mood disorders - Faulkner, Woolf, Poe, Twain, David Foster Wallace; Charlie Parker, Thelonius Monk, Charles Mingus. And how intensely I felt about understanding the brain.

Once again, I'd gotten things wrong. As Sarah heard my story, her blue eyes were as kind as always, less shocked than relieved to know for sure. The me who Sarah knew was already the raw nerve of moody buzz that I am. To tell her that I'm prone to talk, to chasing curiosity with the zeal of Ahab and, off meds, to sleepless binges of writing and lust, was like confessing, with hesitant shame, that my eyes are brown.

Since the hospital, there was a story I'd come to believe: I was broken. I was not worthy of love. During the first months of dating in New York, I avoided getting close enough to any woman that I'd have to tell her about the pills. No woman should trust me, I thought, and reveled in that. The myth that I was toxic fit the hard boiled persona of the melancholic music and books I love, in a solipsistic way I found addictive.

But my talk with Sarah that day lifted the spell. The vain belief that I was isolated, in a way as glamorous and romantic as it was tragic, began to recede. Just like every happy lover, I got hooked on how good it feels to share a life with someone else. I learned that she, too, was full of jagged moods that sometimes scared her. There was nothing we couldn't bring out into the open now.

Together, even in darkness, we could laugh.

Sarah and I parted eventually, but our time together taught us things, as intimacy always does. There seems to be a type, I learned, who appreciates mania-prone people, not for recklessness, or some other pathological nightmare trait, but for who we are, when we are sane: the manic personality we keep.

I've taken lithium for three years now. I don't feel much different from how I was before age twenty five, before the mood swings began. But I'm far more self aware, far less afraid. Demons aren't real. Peel back the gothic fairy tale of mental illness, and what's left is just the human - the hope, as bold and fragile as a candle in a cave, that somewhere there is someone for you.

Washington Post

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