Dawn Howard lives with Bipolar II. (Photo provided)
This story discusses suicidality and bipolar disorder. If you or someone you know if contemplating suicide, please call or text the National Suicide Prevention Lifeline at 988.
When Dawn Howard was first diagnosed with bipolar II disorder, she immediately had to face stigma — from herself.
“I didn’t want it, because I was like, ‘No …. that’s for crazy people. Like, that’s legit crazy people stuff,’” she recalls thinking.
She rejected the diagnosis, and didn’t get medication she needed to manage her symptoms for years.
Once she did, she says her life stabilized and improved, giving her hope for the future, which she now wants to share with others in similar situations.
Howard, 45, mostly deals with depression, which is common for people with bipolar II.
The Louisville woman, who is originally from Owensboro, thought her manic symptoms just meant she was really productive. During her lows, she thought of death.
Because she was more depressed than manic, it took her years to get an accurate diagnosis. She finally received it in 2012 following a manic episode during which she felt “like my head’s about to fly off my body,’” she recalled.
Kentucky therapists who treat bipolar said the condition, while not curable, is manageable with the right treatment.
About 40 million people — 0.5% of the world’s population — have some type of bipolar, according to The World Health Organization. Cambridge University Press lists bipolar among the most stigmatized mental health conditions. It’s unclear how many Kentuckians live with bipolar.
What is bipolar disorder?
Ghazel Tellawi, a Louisville-based psychologist who treats bipolar, among other conditions, said Bipolar I is characterized by a person having at least one manic episode, which can be followed by hypomania, which is similar but less severe than mania, or depression. People with bipolar II have had at least one hypomanic episode.
A manic episode in bipolar I lasts around 7 days, according to the National Institutes of Mental Health, whereas bipolar II episodes are similar though less severe.
Manic episodes feature out-of-character risky behaviors, explained Amanda Akers, a Morehead-based psychologist. During these episodes, people may lose a lot of sleep, stop feeding or cleaning themselves and be unusually impulsive. Because of their extreme nature, these episodes are easy to spot.
“Usually it’s so severe that people with a manic episode end up being treated in the hospital or ending up in the criminal justice system in jail because of something that happens during the episode,” Akers said. “It’s so significant. It’s not something that’s going to pass you by that you’ve had a manic episode.”
Often, a person’s hospitalization during a manic episode is what leads to their diagnosis.
Hypomanic episodes, characteristic of bipolar II, are similar in nature but “don’t rise to the level of a manic episode,” Akers explained. People with hypomania have episodes lasting four days straight. They have major depression and their self esteem plummets.
People with bipolar have “some genetic vulnerability” to the condition, Akers said, which starts to manifest in late adolescence and early adulthood.
While brain scans can show bipolar’s effect on “the density of neurons in some parts of the brain,” brain scans alone can’t diagnose the condition, Akers said.
Suicidality and suicide attempts are highly prevalent among people with bipolar. According to research published in the National Library of Medicine, between 25% and 60% of people who have bipolar will attempt suicide at least one time while up to 19% may take their lives. The National Suicide Prevention Lifeline is 988.
Thoughts of suicide among bipolar patients are “a very big concern,” Akers said. “It unfortunately goes hand in hand with bipolar.”
That’s one of the many reasons, she said, that staying on mood stabilizers is key for those patients.
Dawn Howard’s story
Howard’s bipolar II — characterized by depressive lows — left her unable to clean. Her home, she said, was “absolutely out of control, bad.” She went years without company.
“My furnace went out and I was too embarrassed to let somebody in my house to fix it,” she recalls. “So it just got to 48 degrees in my house. Like, what am I going to do? Because I can’t let anybody come in and look at my house.”
This only fed her “spiral” of depression, she said. “Just sitting in it every day pulls your mood down because you feel so gross and useless,” she said, “and that makes your depression worse and worse.”
She finally found a provider she could trust and got on antidepressant and mood stabilizing medications. She brought in someone to deep clean her home, which is now a “real feeling of pride” for her.
“Because I have bipolar II, I don’t have these … life ruining, ‘I gambled my house away and I slept with 35 people last night’ … kind of things,” she said. “But I was not sleeping and becoming increasingly agitated, irritable. You couldn’t talk to me about anything. I would just snap about anything, talking a mile a minute … just acting kind of erratically and not like myself.”
Meanwhile, Howard, who is the director of finance at a Louisville nonprofit, wants people to rethink stereotypes they’ve learned about bipolar.
“Bipolar doesn’t make me commit crime,” she said. “It made me buy a car once in a day after I decided I wanted a car. It does stuff like that, but like, it doesn’t make me do crimes.”
Internalized stigma
The internalized stigma Howard had to work through isn’t uncommon among individuals with bipolar, Tellawi said. People who get bipolar diagnoses often face that internal “threshold,” she said.
“I think people do feel that way, especially because it often means that you are probably going to be on medication for the rest of your life,” she said. “It’s a chronic condition. And if you want to keep it managed, you are most likely going to be on medication forever.”
The idea of being reliant on a daily pill to “maintain” mental health is “really hard for folks,” said Tellawi.
But: “If you have a thyroid issue or if you have diabetes, you are going to be on a medication for the rest of your life. But we don’t have that same stigma attached to it because it’s medical.”
Akers agreed.
“I think … that the internal stigma is greater even than the external stigma, because I think people can be very understanding these days,” she said. “But to think something’s kind of internally wrong with you is much kind of harder to cope with.”
But, the therapists say, getting the right treatment — medication and therapy — allows people with bipolar to live balanced and well-adjusted lives.
Even though there is no cure, they said, there is hope.
‘Keep trying.’
Howard would like people to stop using “bipolar” in a cavalier way.
“I get annoyed when somebody’s moody, and they’re like, ‘oh, that person’s so bipolar,’ and they just mean … ‘they’re a moody person.’ That annoys me a lot, because this condition, at many times, has come perilously close to ruining or ending my life. And I don’t really like people to be casual about it.”
Therapists who treat the illness agreed. Akers said bipolar is often misdiagnosed, and there are misconceptions about the illness in popular culture.
“I think the general public has an idea that if you’re kind of moody, you have mood swings, you can go from one emotion to the next, that that makes you bipolar, and that really isn’t the actual experience of the symptoms,” she explained. “That’s more like …. unstable emotional functioning that can be symptomatic of other things, like borderline personality disorder.”
Howard still lives with periodic suicidality, but she’s learned how to reason with herself in those moments.
“I do a lot of self-talk. One thing that I do when I’m feeling in those kind of ways is I look through my pictures of me and my friends having a really good time and being like, ‘oh, Dawn, see, people love you, people like you. Remember when this friend did this thing for you? They wouldn’t have done that for you if they didn’t like you,’” Howard said.
She is able to pull herself out of those thoughts, she said, but “it’s just a constant reminder that the brain is sick.”
I get annoyed when somebody’s moody, and they’re like, ‘oh, that person’s so bipolar,’ and they just mean … ‘they’re a moody person.’ That annoys me a lot, because this condition, at many times, has come perilously close to ruining or ending my life. And I don’t really like people to be casual about it.
– Dawn Howard
Howard thinks having free mental health care would help people like her.
“I’m incredibly privileged to be able to say ‘my mental health is worth enough’ and I’m just going to hand over my credit card and close my eyes every time,” she said. “But it needs to be more accessible from a cost perspective. And then, also, we’ve got a supply issue. And I don’t know the reason for the supply issue, but I know that there’s a very long wait, often, to see therapists.”
She’d like to see policies put in place to incentivize people to enter the profession, she said, such as a loan forgiveness program and regulations allowing more providers to prescribe mood stabilizers.
“The message I would give the people who have it is to keep trying. So, however many times you get a medication combination that doesn’t work for you — keep at it, because eventually, if you get the right prescriber talking to you and listening to your concerns, eventually you will hit the right mix,” Howard said. “It took me years to hit the right mix, but it’s been very, very worth it.”
How to spot bipolar — and what to do about it
Therapists who treat bipolar say there are some key behaviors that can indicate bipolar. While people who are in the midst of a bipolar episode might not be able to spot the patterns of symptoms themselves, loved ones may make a note of these signs:
- The person is not sleeping normally. They may be getting as little as three hours a night for several nights in a row.
- Despite sleeping less, the person has more energy.
- They are very talkative, cannot stop talking fast and it’s difficult to follow the train of thought.
- They do something impulsive and risky that is out of character. This could include doing a lot of drugs, having sex with a lot of people and spending a large amount of money that’s unaffordable.
- They are having delusions.
The first step in getting help is getting in to see a psychologist for an evaluation, therapists say.
Anyone in immediate danger of harming themselves should call or text the National Suicide Prevention Lifeline, which is 988, or go to the hospital.
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