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This is what it’s like to be bipolar

This is what it’s like to be bipolar

The contrast between the highs and lows is extreme with bipolar disorder.

The contrast between the highs and lows is extreme with bipolar disorder.
Warpboyz / Shutterstock
  • Bipolar disorder affects about 1-2% of the population.
  • It’s characterised by manic episodes, depressive episodes, and potentially some psychosis.
  • Katherine Ponte spoke to INSIDER about what it’s been like to live with the disorder for the past 15 years.
  • She had several manic episodes where she thought the world was coming to an end, and went through periods of severe depression.
  • Being manic gets you into trouble, but it’s the depression that can kill you, she said.

When Katherine Ponte had her most extreme manic episode, she ended up on John Lennon’s “Imagine” mosaic memorial, lying down in Central Park, thinking the world was coming to an end.

She had previously been in hospital for about a month, but as soon as she came home she threw all her medications down the toilet. She truly didn’t believe there was anything wrong with her, and she refused to accept her diagnosis of bipolar 1 disorder.

Ponte’s husband watched as tourists surrounded her and laughed and took pictures. An ambulance finally pulled up and wrapped a sheet around her head to toe and placed her in the back.

“They said they had a ‘wild one,’” Ponte told INSIDER. “And I remember that very clearly… It was very difficult to hear that because you feel like you’re an animal the way they refer to you.”

There is a huge contrast between high and low moods

Ponte was first diagnosed with severe bipolar 1 in 2000. Bipolar 1 is a mental health disorder characterised by manic or hypomanic episodes, depressive episodes, and potentially some psychosis.

According to the mental health charity Mind, mania “lasts for a week or more and has a severe negative impact on your ability to do your usual day-to-day activities – often disrupting or stopping these completely.” Some of the symptoms are racing thoughts and speech, delusions and paranoia, hearing or seeing things other people don’t, and being uncontrollably excited.

People in bouts of mania are hard to communicate or reason with, often talking a lot at high speed, and saying things that don’t make a lot of sense. They may be rude and aggressive, or behave out of character. It’s also sometimes associated with taking serious risks with their health and wellbeing. For instance, many misuse drugs, act dangerously, or spend an inappropriate and excessive amount of money.

After a manic episode, people with bipolar 1 disorder may then feel ashamed about how they behaved, or they might not remember it at all. They may also fall into a depressive episode where they feel down, upset, lacking in confidence, or even suicidal.

“Many people find that a depressive episode can feel harder to deal with than manic or hypomanic episodes,” it says on the Mind website. “The contrast between your high and low moods may make your depression seem even deeper.”

Ponte said that being manic gets you into trouble, but it’s the depression that can kill you.

“When you’re manic, you don’t think you’re going to die, you think you’re on top of the world, you can do anything,” she said. “But it’s when you’re majorly depressed that these thoughts of suicidal ideation come to you.”

Denial and stigma

There were a number of triggers in Ponte’s life at the time of her first manic episode, including academic stress, doubts about her career, being wrapped up in issues of social injustice, and being sexually assaulted.

“All of these things came together in a very short period of time,” she said. “That’s what really triggered my mental illness, and at the beginning, I had a very difficult time with it.”

But although she was diagnosed within minutes at the office of counseling and psychological services at her university, Ponte was in denial. There was a lot of stigma at the time, she said, and after trying several different medications that didn’t work, she stopped getting any treatment.

Then in 2006, she had a major manic episode, where she made religious shrines and thought she was receiving messages that the end of the world was imminent. Her husband returned home to find their apartment trashed, so he called 911 in a panic. Within 15 minutes Ponte was surrounded by four armed NYPD police officers and two paramedics in her living room which, understandably, freaked her out.

She was taken to hospital, placed on a gurney and injected with chemicals. Later, she woke up in leather restraints and was taken to solitary confinement – a room empty except for a two-inch thick mattress, because everyone on a psych ward is on high alert for suicide.

“And they have guards which just adds to the feeling that you’re being watched and every minute, every second,” Ponte said.

“It feels a lot like a jail. You can’t come and go, people rifle through everything you bring in with you, there’s no fresh air, you can’t go outside, there’s no breeze.”

She was also heavily sedated – as was everyone else around her. Every day her lithium levels would be checked, which she found discouraging because she realised “just how bad a state” she was in to be put in a place like that.

But it wasn’t enough. As soon as Ponte got back home, she threw away all her medications. That’s how she ended up at the John Lennon memorial.

“I thought I wanted to save the world,” she said. “Yeah… it gets that way.”

John Lennon's memorial in Central Park.

John Lennon’s memorial in Central Park.
Son of Groucho / Flickr

Ponte finally accepted she needed help when she came back from hospital and went to go see a psychiatrist. But what followed was a string of bad experiences, including one doctor who kept falling asleep in her sessions. Another psychiatrist changed her medication, and she put on 60 pounds in less than three months.

“I just felt like a balloon,” she said. “I told her that I wanted to come off it, she made a medication adjustment, and quickly after that medication adjustment, I went manic.”

During this manic episode, Ponte had more religious preoccupations and broke into a house of worship. She befriended a homeless man and invited him back to her house for somewhere to sleep. Her husband was furious, and immediately threw him out, but Ponte wasn’t able to recognise the problem.

She said at this time, before getting the right treatment, she had no hope for any sort of answers or recovery. Her psychiatrist told her she would only get worse and her manic episodes would get stronger and more frequent.

“This is often the grim diagnosis that people with mental illness face,” Ponte said. “They’re made to believe there is very little chance that they will recover. And this is one thing I take very big issue with.”

‘Living before treatment was living without hope’

But after another manic episode in 2014, Ponte finally found someone who could help her. She had lacked faith in health professionals for over a decade – but then she was referred to someone called Dr Goldberg by the Stanford University Bipolar Disorders Clinic.

“I just had a very good rapport with him,” she said. He was attentive and listened to her concerns about her medications and didn’t dismiss them.

“A lot of people don’t understand the side effects of medication,” she said. “They think if you’ve gained all this weight, you must be lazy, sitting on the couch, eating junk food. And they also think because you’re sleeping as much as you do, and you look as garbage as you do, that you must not be active enough.”

So often the advice given to people struggling with their mental health is “go out, do something, get some exercise.”

“That’s really disheartening to someone with mental illness because they don’t want to sit there and explain,” Ponte said. “I’m on this medication, which may make me gain a million pounds, and I’m on this medication that keeps me asleep all day. You just get very discouraged when you hear those sorts of comments.”

Without the right treatment, it can feel like things will never get better.

Without the right treatment, it can feel like things will never get better.
Aipon / Shutterstock

Thanks to building trust with her psychiatrist, Ponte hasn’t had a manic episode in over four years. She started working towards her goal of having a career and starting a family, and started up ForLikeMinds, a resource for connecting people with others who are going through something similar to them – whether it’s mental illness, substance use, or the stresses of life.

Ponte knows first hand how hard it is to face a diagnosis. In the early stages, you want to shut it out, she said, and think about it as little as possible. But when you start to accept it, you want to learn more and more about your condition, and she aims to help people out with that.

It’s also hard every step along the way. Often, people with bipolar stop taking their medicine because they start to feel better. Some come off it because they miss the way it feels to be manic.

Someone with bipolar is never fully recovered

Ponte knows she is living with her mental illness and that it will never go away. You’re living in a state of recovery, you’re never recovered, she said, “it just means that you’re living with it in a way that doesn’t take away from you living a full and meaning for life.”

Ponte’s manic episodes put her in hospital in 2006, 2010, and 2014, so this year fits in with the four year pattern. But she feels she has enough control over her treatment and mental health that it won’t derail her life completely if she has another episode in 2018. She also can’t wait for the stigma of mental health to go away to start living a normal life.

“People with mental illness, they can’t just wait around for a stigma to go away for them to start taking more control of their life and believing they have that possibility,” she said. “Recovery gives people hope, and I want through my work, using my example, to give that hope. I haven’t been sick since 2014, and I feel really good.”

It’s all about giving people the right environment to let them dream again, she said, and learning that it’s not about defeating your mental illness, but coexisting.

“I spent many years battling bipolar and fighting with it, and arguing with it and saying ‘go away, leave me alone,” said Ponte. “But I finally came to accept it… I came to accept that this is in my life and so I have to learn how to coexist with it, and I have to learn the best way to coexist with it, because I can’t let it overtake me.

“People are able to control it. You are able to tame it, if you know how to.”

‘Gaming disorder’ has been classified as a mental health condition by the World Health Organization — here’s what that means

‘Gaming disorder’ has been classified as a mental health condition by the World Health Organization — here’s what that means

  • The World Health Organization has added “gaming disorder” to the list of mental health conditions in its next update of the International Classification of Diseases, its standardized list of diseases and other medical conditions.
  • Playing too many video games could become problematic if the behavior causes a person’s relationships or performance at school or work to suffer, according to the definition.
  • Although games can potentially become too compelling for some people, they also have some psychological benefits.

The World Health Organization has added “gaming disorder” to the list of mental health conditions.

The addition will appear in the new version the International Classification of Diseases (ICD), the WHO’s standardized list of diseases and other medical conditions used by countries around the world, which was released on Monday.

The addition is meant to help clinical professionals define the point at which a pastime or hobby of playing video games becomes problematic. That could also help individuals who feel they are struggling with gaming get treatment.

The ICD now lists gaming behavior as disordered if it meets three conditions: if a person loses control over their gaming habits, if they start to prioritize gaming over many other life interests or daily activities, and if they continue playing despite clear negative consequences. This pattern should be clear for a one-year period before a diagnosis is made, according to the definition.

This adds gaming to a list of behaviors that can become problematic if people lose control over them, including gambling and disorders related to the use of substances like alcohol, marijuana, caffeine, or nicotine.

However, defining behaviors like gaming as addictive or as mental health conditions is still controversial. Some researchers argue that problematic gaming behavior is often a symptom of mental health struggles, rather than a mental health condition by itself.

There are lots of forms of gaming, some solo, some social.

There are lots of forms of gaming, some solo, some social.

Severe enough to harm personal relationships

The term “gaming,” of course, covers a wide range of activities that can be solo or social pursuits. It includes playing a quick puzzle game on your iPhone while riding the subway, meeting up with friends to play “Minecraft,” and sitting down at a custom-built PC for a multi-hour “Destiny 2” raid session.

The WHO’s definition is not meant to imply that any one sort of gaming is addictive or to say that a specific amount of it leads to a disorder. Playing video games only would qualify as a mental health condition if the behavior is severe enough to result in “marked distress or significant impairment in personal, family, social, educational or occupational functioning,” according to the WHO.

In other words, it has to be harming personal relationships or interfering with school or work.

“Gaming disorders are uncommon, but still very important,” Dr. Shekhar Saxena, director of the WHO’s department for mental health and substance abuse, said in a YouTube video discussing changes made to the ICD. “ICD has to keep pace with evolving disorders and diseases, and this is one of them.”

witcher 3

CD Projekt RED

The psychology of games

The psychological community has been debating whether gaming is addictive enough to be described as a disorder for some time. So far, the American Psychiatric Association has declined to classify gaming addiction as a disorder but has said it merits further research.

Before the WHO’s decision, the Society for Media Psychology and Technology Division of the American Psychology Association released a statement expressing concern about the idea of “gaming disorder,” due to insufficient research on the topic:

“[R]esearch has not provided clarity on how to define video game addiction (VGA), what symptoms best diagnose it, how prevalent it is, or whether it truly exists as an independent disorder, or, when it occurs is merely symptomatic of other, underlying mental health diagnoses.”

Part of the problem is how to distinguish between simply spending a lot of time playing games and actual addictive behavior.

Scientists need to “establish a clear-cut distinction between someone who may use games excessively but non-problematically and someone who is experiencing significant impairment in their daily lives as a consequence of their excessive gaming,” a group of researchers from Nottingham Trent University in the UK wrote in a paper published last summer in the Journal of Addictive Behavior.

There are plenty of stories about individuals whose gaming behavior has become problematic – people have gotten so caught up in online games that they’ve ruined relationships and lost jobs. Games are often designed to compel people to keep playing and in some cases, to keep spending money. Compulsive gaming and problematic substance use can also go hand in hand.

But problematic gaming may also serve as a dysfunctional coping mechanism for some, according to the Nottingham Trent researchers. Someone who is struggling with depression or anxiety may turn to gaming or abuse substances like alcohol as a way to relieve those symptoms.

Ben Gilbert / Tech Insider

Benefits, harms, and “gaming disorder” going forward

Figuring out the degree to which playing games is harmful (or helpful) is all about context, according to Bruce Lee, an associate professor of international health at the Johns Hopkins Bloomberg School of Public Health. Lee wrote in a column for Forbes that gaming habits can also be psychologically beneficial.

On the positive side, research has shown that game playing can relieve stress, improve problem-solving abilities, and enhance traits like eye-hand coordination. Technologies that we think of as built for gaming, like virtual reality, can also be used in psychological therapy.

Yet people can struggle to find a healthy balance with gaming.

Researchers are still trying to understand the activity’s risks and effects, since it has only recently become such a common pastime – 63% of US households contain at least one “frequent gamer,” a trait that didn’t exist a couple of generations ago.

The WHO creates the ICD list so that every country can use a standardized system for classifying diseases. That allows for a unified way of identifying illnesses and keeping track of how common certain diagnoses are.

But it’ll take some time before the ICD actually gets implemented by countries around the world. Each health care system decides when to start using the updated list, which requires changing various forms of medical record-keeping. The US didn’t adopt the last version of the ICD until 2015, despite it being finished in 1992 and first adopted by some members in 1994. As member countries adopt the new system, they’ll decide how these diagnoses should be treated by healthcare systems and insurance companies.

In the meantime, research into the effects of gaming will continue.

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