It is October and the season here in San Diego changes in tender watercolor blurring toward fall -- the pool emptied of children, a few leaves and dead bees making circles on the surface, the wind carries a damp nesting smell, the skies dim. And just as suddenly, the heat mushrooms again, the pool shines turquoise with chlorine, the wind cackles dry and hot. I notice the second I step outside, and think of how swift change is, how merciless, how aloof. My husband, ill with bipolar II for months, is suddenly "better."
Suddenly he is himself again; he is mine, and the children's. I hate this disease, I think to myself for the hundreth, thousandth time. Bipolar, so insidious, so painful, and too often, deadly: The suicide rate hovers around 20 percent.
Bipolar is an actual disease of the brain, its occurrence largely dictated by biology, with a risk rate four to six times that of the normal population for a person with a parent or sibling with the disease. My husband is one of the unfortunate whose symptoms presented as a teenager and looked like depression until he hit 20 and the hypomania began -- severe irritability, clouded, irrational thinking, memory loss, rapid speech and dramatic, unrealistic expectations, followed by fatigue, suspicion, depression, lack of appetite, sleeplessness, nightmares. When this first began, our marriage exploded. He sat me down at the kitchen table one evening and simply said, "I can't do this anymore." I was in shock, disbelief: Where was my husband? I found out later he only realized how close he had stood to the edge when he was safely on the other side. In the grip of bipolar, people don't have "normal" feelings or thoughts. Our long journey back to each other involved dedicated steps by both of us on a path we are still walking.
Each episode of severe depression and hypomania damages the brain and makes it harder for a person to recover, so earlier diagnosis and treatment is ideal. In addition, treating a bipolar patient with depression medication usually causes them to have a bipolar episode, sometimes severe. Often, the incorrectly diagnosed patient believes the medication just doesn't work for them, not realizing it is simply the wrong disease being treated.
Luckily, my husband was diagnosed correctly before too many years passed and, after trial and error with medications, found one that works well for him. But! The caveat is that even bipolar medications that work well aren't foolproof, and during a busy, stressful time my husband ran out of medication and was already sick by the time it came in the mail. He also had been struggling to get to sleep at night, and sleep is, as bipolar expert (and sufferer) Kay Redfield Jamison says, the number two most important way to stay well, after medication. My husband has a rigorously disciplined sleep schedule that I admire, which keeps him even and available for his family. He is usually asleep by 9 p.m. and awake at 5:30 a.m. It prevents the illness from taking hold, especially during times when the brain is more vulnerable, like during great stress, intense weather changes, long dark days of January.
We both understand the rules of behavior when he gets sick -- his and mine. In the first years, I furiously tried to "talk him out" of his emotions and behaviors when he was sick, a futile and damaging thing to do that came from sheer ignorance, fear and hurt. Once I was better educated about the disease, I understood that practical measures would help -- see the doctor, adjust meds, sleep control, reduce stress, give space -- but that emotional ones would not. He also takes a high-dose fish oil supplement, gets regular exercise and eats healthily.
Our marriage has suffered because of bipolar, but because we choose to be honest with each other, and to put our family first, we have been able to make it work in a way that does not wreak havoc on our family life. And the great swaths of time when he is not ill, we are incredibly happy -- in love and best friends, a marriage I cherish.