Missing Mania

A patient tells me that the lithium is working.  "It keeps me neutral", she says.

"How do you feel about that?" I ask.

She tells me that she had a panic attack on her way home from the bus stop and that it lasted for several hours.  The thought that set it off was that she would never be manic again.

"Who am I without mania?"  She asks.  "Being neutral all my life makes me feel like such a waste of space."

Up to this point, we had had several appointments.  There was the initial consultation where I had gotten to know her history and the complaints she had about her mental health.  From that assessment, I had established a diagnosis of bipolar disorder and suggested she start a mood stabilizer.

She was very willing to try medication and in subsequent appointments I got a sense of the significant impact her manias have had on her life.  She once spent $5000 in one evening on jewellery, putting herself into debt.  Then there were the STIs she contracted after a string of one night stands with strangers she picked up from the bar.

I never stopped to think that she would miss her mania.

On this day, she tells me how alive she feels when manic, how confident and witty she becomes, and how love and attraction feel electrifying.  She describes an intensity to her feelings that seem impossible to access now.  Now that she is on medication.

"I feel neutral, numb", she says.

"Do you want to stop the medication?" I asked, not sure that I wanted to know the answer.

"No, no, that would be a terrible idea.  But do you think this medication is making me numb?"

This is a question I get often, and I admit that indeed many of the medications I prescribe (mood stabilizers, stimulants and antidepressants to name a few) can cause people to feel emotionally numb and blunted.

"Yes, it is possible the dose may be too high," I said, "but I am aware of your history of trauma, and trauma too can make you feel numb even without medication".

She thought about this.  She then told me about how she recently saw a posting from her estranged mother on social media.  It was a video of her mother singing a song to her new child, a son, and it was the same song my patient used to dance to with her mother.  It was a rare moment of happiness in an otherwise chaotic and abusive upbringing.

"I know it is stupid, but I burst into tears when I saw that video. I was a mess. I thought I was over this," she says.  Her mother was only a teenager when my patient was born and they had been estranged for years.

"Perhaps you are not so numb afterall," I thought out loud, looking at her to see how she registered my comment.

She nodded and told me that she was so used to having feelings of intense depression followed by euphoria that were unpredictable and uncontrollable.  The only explanation that made sense to her was that she had a mood disorder.  She never had to think about her trauma and their impact.  Her moods episodes kept her busy enough.  So it was very disorienting for her to have feelings that, for the first time in a long time, were appropriate to the situation and unfortunately, very painful.

She took a big breath, "I have no excuse now to not deal with my trauma and loss," she says.  She seemed to already understand that this was the only way to begin to thaw.  "I just don't know if I am ready."

I am in awe of this woman's courage.  What a difficult choice:  The severely disruptive and disabling consequences of untreated bipolar disorder or the more painful reality it obscures?