Tag: bipolar Identity


I sit on the board of directors of the Depression and Bipolar Support Alliance (dbsalliance.org) an organization dedicated to helping those living with mood disorders.  At our quarterly meeting in December, I sat in a room with like minded people working hard to better the lives of others.  It’s an honor to belong to such a group of good souls whose hearts are in the right place.

Belonging and Attachments

We humans are wired to belong.  Belongingness (yes, it’s a word) is a state of being an essential or important part of something: our primary relationships, our families, our friend groups and our communities, amongst others. Those living with depression and bipolar belong to the mood club.  As members, it’s true that we’ve paid our entry fees with episodes of depression and mania but…we’re in.  Because of this, we find sanctuaries filled with shoulders to cry on, nourishment for our souls and kindred spirits with whom we share our hopes and dreams.  It is only through these connections that we can be the best of whom we are. I don’t believe it’s possible to travel this pathway toward our better selves on our own.  To do so, we must belong.  Through the attachments that come with belonging, we come to know others and allow others to know us in the most genuine of ways.  What more precious gift is there?

Belonging and the Big things

This state of belongingness has allowed me to navigate through adversity.  This, in turn, has compelled me to slow down and get lost in life’s sweet little moments and, at the same time, see the larger things that matter the most:  compassion, kindness, decency, authenticity and true connection to others.

Belonging and Sacred Gifts.

Belongingness has given me precious gifts:  being my better self, knowing others and allowing them to know me, seeing myself honestly as I navigate through adversity, claiming ownership of myself without secrecy, pausing more often to smell those proverbial roses and reaffirming the deeper and most important things in life.  Belongingness has made me richer in all the ways that matter the most to me.  Belongingness has allowed me to know the love of others in ways that I wouldn’t have otherwise.  Belongingness has given me these most sacred of gifts.  I’m very lucky to belong.

Bipolar Disorder in Men

I was asked to share my thoughts on the topic of Bipolar Disorder in Men by the wonderful International Bipolar Foundation. They provide education, advocacy and support for those living with Bipolar Disorder….here’s the piece I contributed.

As a psychiatrist living with bipolar disorder, I have been both a care receiver and a care giver. Over the span of my career, I have treated many men with bipolar disorder having the luxury of viewing them through the lens of being both a clinician and a patient. Though men and women have the same lifetime prevalence of bipolar disorder, it has been my experience that the expression and co-morbidities differ notably between the genders. To begin with, allow me to review some basic facts.  It appears that men have an earlier age of onset of bipolar disorder than do women.  Men are likely to exhibit their first symptoms at age 22, on average, with women typically having an onset three years later.  The literature, affirmed by my own experience, suggests that men are more likely to have their initial mood swing be mania while in women it is more likely to be depression.  Some studies suggest that men have a greater number of manic episodes over the course of their illness than do women and these manias are associated with more intense levels of aggression in men.  As well, depressive episodes in men are more frequently associated with irritability than is the case with women.  Of note, men with bipolar disorder are much more likely to have co-occurring substance use disorder than women.  Some have suggested (I agree) that it can be more difficult to diagnose early onset mania in men because some of the typical manic symptoms (aggression, over-confidence and boldness, for example) are traits that we often associate with masculinity. 

signpost with man and woman written

Gender Stereotypes

Our cultural gender stereotypes play a large role in how men react to having a psychiatric illness.  There is great stigma attached to having a mental health condition, especially for men, in my opinion.  Males in our society are encouraged to be invulnerable, self-sufficient, in control and emotionally level-headed.  Expressions of affect are frowned upon and judged as being “weak”.   We expect our men to be stoic and “strong” and harshly judge those who fall short of this unrealistic and unhealthy expectation.  It is no surprise then that men are more likely to deny their illness than are women.  I shunned treatment for far too long even though I was a psychiatrist and knew my diagnosis.  Those with untreated bipolar disorder suffer needlessly and the higher rate of suicide amongst men is heartbreaking.

Reasons for Hope

Though these statistics are sobering, there is much to feel hopeful about.  It is clear that men respond just as well to treatment (medication, therapy and group support) as do women.  Exercise, healthy eating habits and good sleep habits are the three pillars of self-care that many with bipolar disorder regularly incorporate into their daily lives.  Millions of men across the globe have stepped forward and are receiving the care that they need.  We hear with regularity from those in the national spotlight (celebrities and sports figures, for example) who come out of the mental health “closet” and publicly acknowledge that they have bipolar disorder. My own experience is reason for others to be hopeful.  I shunned psychiatric treatment for far too long for fear of being judged and because of the stigma against mental illness in the medical community.  When I have shared my diagnosis at conferences and with colleagues, family and friends, I have been stunned at the response, receiving more affirmation and hugs than I could have ever imagined possible.  My own harsh self-judgements evaporated as I have been fully embraced.  Mine is a story like countless others.


I believe that all those who share their journeys reap unexpected benefits.  For me, there has been something even more important.  I now embrace having bipolar disorder.  It has allowed me to connect with others in genuine, heart-felt ways and to be part of a wider group of kindred spirits.  There is nothing quite so powerful and freeing as authenticity.  Being true to who we are requires fortitude and courage. In my work over the years, I have seen time and time again that men are much more likely to accept their diagnosis if they view doing so as an act of courage.  Which it is.  So, I would offer this advice to my fellow male travelers: when you are ready, tell your story.  We change the culture of silence one conversation at a time.  Have the audacity to be part of this long overdue dialogue.  You will engender the respect of others in ways that you hadn’t thought possible.  When you do, you will see a man staring back at you from a mirror filled with humanity, authenticity and pride.

A Thousand Steps…

If we take a thousand steps, we’ll have travelled some distance whether we’ve reached our destination or not.

Woman descending steps on a mountaintop

Three months ago, I relapsed into a mixed mood state, having symptoms of depression and hypomania at the same time.  This took me by surprise since I had been psychiatrically stable for the past several years.  Why I slipped into this destabilized state, I do not know.

Losing myself

In response to this, the recommendation from my psychiatrist was to double the dose of one of my medications and within a few weeks my mood symptoms resolved and I felt back to my usual self.  Or so I thought.  Sometimes, it’s only in retrospect that I realize that all has not been not so well.  It was only after a month of being a good patient and taking the elevated dose that it was obvious that something was wrong.  I wasn’t having mood symptoms but I was lifeless without any interest in doing anything at all.  I’d just lay around all day not writing, cooking, exercising or otherwise engaging in my life.  This wasn’t depression, it was a side effect of the medication.  I made the decision on my own to return to the lower dosage and a few days later, emerged from my deadened state.  I was alive again.  I know that despite feeling better, on this current regimen, my mood symptoms are going to express themselves and I will become ill again.

The half or zero dose guy

If halving my medication caused me to re-awaken, how could I be sure that the remaining dosage wasn’t having some deleterious effect?  If I stopped taking it all together, might I become even more alive?  Who am I? Am I the half dose guy or the zero dose guy? Am I still trapped beneath the weight of this smaller pill I take everyday?  I’m tempted to experiment and stop all my meds and find the answer.  I understand non-adherence to recommended care.

A thousand steps…and more

I continue to face what many who have psychiatric disorders face.  Still searching, after so many years, for that combination of medications that will stabilize my mood yet won’t suffocate the real me.  As a psychiatrist, I understand the challenges of this delicate balancing act.  That said, I’m rather frustrated and pissed off that I’m forced to continue this wearying journey.  It seems, at times, that there is no end in sight but I have no option other than to soldier on in this (so far) elusive search. I don’t think my feelings arise from a place of self pity. They are instead a sober realization that a thousand steps hasn’t been nearly enough.

I Miss the Mountains

Hijacked by my Brain

I took a hike a few months back in the Blue Ridge Mountains, outside Asheville, North Carolina.  Having scaled one of the peaks, I sat and saw the expansive valley below from my lofty perch.  The sunshine warmed my face as I inhaled the cool, crisp air.  I was on top of the world.

As all others living with bipolar disorder, I had periods when I was driven down to the abyss of depression and then episodes when I was elevated to the heights of mania. I couldn’t predict when my neurotransmitters would hijack my brain but they inevitably would. I was being repeatedly kidnapped.

The Mania of Love

Though my manic periods were ones of agitation and irritability, they were also times of euphoria and grandiosity.  I was the smartest guy in the room, walked with a bounce in my step and felt that I was capable of doing things that were, in reality, well beyond my reach.

When we have a huge crush on someone, the world falls away and all that is rational is replaced with heady infatuation.  In this state, we behave in ways we wouldn’t otherwise, throwing all caution to the wind.  Everything feels tingly, as if we are living on the edge of ecstasy.  This is a small glimpse of what mania is…an other-worldly intoxication.

As a psychiatrist, it was my duty to un-manic my patients.  I was required to shift their state of giddiness into, at times, one of bland sobriety.  I was like a thief in the night, robbing them of what they most loved.  Turning the tables, when my psychiatrist recommended lithium to me in our very first session, I was literally being given a taste of my own medicine.  The psychiatric perpetrator had become the psychiatric perpetratee.

Mountaintop Highs

A few years back, there was a Broadway show called Next to Normal about a mother living with worsening bipolar disorder. Once she was medicated and mood-stabilized, she longed for those periods when she was mountaintop-high manic. She sings:

Mountains make you crazy

Here, it’s safe and sound

My mind is somewhere hazy

My feet are in the ground

Everything is balanced here

And on an even keel

Everything is perfect-

But nothing’s real, nothing’s real

I wouldn’t trade my current mood stability for my prior elevations given the havoc and heartbreak it caused those around me. But, there are moments when I long for my now-medicated-and-absent euphoric core to rule the day and carry me upward toward that place far above. I love ascending the North Carolina peaks but sometimes, I do miss those mountains.

Bipolar identity: Jekyll or Hyde

Before i was mood stabilized

Before I was stabilized on medications for bipolar disorder, I was very confused about my identity. I was a “moody” guy with good days and bad ones, had periods where I was productive and other times, not so much. I had episodes when I expressed a lot of energy and other times, I felt dragged down. But everyone was like this, I told myself. I was just a moody guy. I didn’t question it. After all, why ask whether it’s dark out at night or light during the day? It just is.

Picture of Dr Jekyll and Mr Hyde in the 1931 Movie

When I finally admitted that I had bipolar disorder and was mood stabilized, I saw my true identity on the inside as even keeled but that I had neurotransmitters that kidnapped my genuine self, pushing me downward into an abyss or hoisting me up to irrational highs. It was a relief to know that I was, at my core, “normal” like Dr. Jekyll but it was awful to know that I could be transformed into the deranged Mr. Hyde whenever my “sickness” expressed itself.

The medications

The experience of having one’s true personhood abducted by their brain is common in those who have bipolar disorder. Our neuro-chemicals cause us to question who we really are. Just as bad, though, the medications we take add to our identity-confusion. Over the years, many of my patients with bipolar disorder have told me that the pharmacopoeia I was prescribing was robbing them of themselves. The pills were causing them to be less fun-loving and their true creative self; their lives weren’t as rich and vital as they were without treatment. Despite my best intentions to help them, I was a perpetrator of their distress. I understood them. I had walked their walk.

Humans must have a clear sense of who we are, defined by our values, ethics, core beliefs and behaviors. Having such clarity anchors us in our world. We can’t have satisfying relationships or meaningful vocations when we don’t know who we are. It’s simply impossible to have a shifting sense of self and live a stable, happy life.

Mood stability

After years of mood stability, I was finally certain about the difference between medication side effects and the genuine, authentic me. I felt good: bipolar was a healthy aspect of my identity. I was fully integrated with a solid sense of self and this provided me with a comfort that I never had experienced before. Perhaps in the future I will have a hypomanic or depressive episode and Mr. Hyde will reappear. When I become stable after that period ends, though, I will know that I am neither Dr. Jekyll nor Hr. Hyde. I am both. I am now a doctor living well who happens to have a mental health condition. It’s as simple as that. Full acceptance of all aspects of my authentic self allows me to have inner peace. I am now whole.

Are you Jekyll, Hyde, neither, both?