Like many people with bipolar disorder mine started suddenly with a major depression episode when I was sixteen. The bewildering event came on without warning and lasted six long months. Besides profoundly affecting my mood it impacted school work and relationships confusing my then girlfriend. Fortunately, one observant teacher recognized the changes in me and my failing work and took it upon himself to do what he could to get me through the episode. The depression resolved spontaneously and left me confused but greatly relieved and without worry about a recurrance. It was misplaced enthusiasm.
Mania, which was to become the dominant feature of bipolar disorder for me, began quietly. Mania is made up of five basic features: accelerated and exaggerated thoughts, rapid and pressured speech, hypersexuality, wrecklesss spending, and lack of need for sleep. I started with excessive confidence, hypersexuality, and spending in mild form starting late in my teens and slowly expanding in my twenties. This was a busy time period for me. I was a hippie paramedic living in Phoenix, Arizona when things started. I was an on-again, off-again student at Arizona State University. My relationships were chaotic and I went through girlfriends as if they were an endless commodity. Eventually I returned to my hometown in New Mexico to attend New Mexico State University in preparation for medical school. I had a religious conversion, cut my hair, met my future wife, and in a whirlwind romance married her.
As a young manic Christian I was, of course, zealous. But I was a demanding new husband and life circumstances challenged our new relationship as we endured four years of medical school. My excessive energy and new workaholism served me well. My first major breakdown occurred shortly after medical school one night on-call as a new intern. Somewhat typical for a sudden serious manic episode it was marked by panic and anxiety. With it came new features of the disorder: sleeplessness, pressured speech, and excessive spending. Unlike many forms of bipolar disorder this manic breakdown persisted for months and failed to ever fully resolve. In the next few years I added a darker side to my symptoms developing a parallel depression to my mania. This is technically called a mixed disorder. Simultaneous mania and depression.
Despite my worsening symptoms and emotional distress I never considered seeking help. I blamed my condition on my stressful life as a new physician and father. But every year brought no relief and I made major career changes in hopes of overcoming my worsening symptoms. It wasn't until a professional crisis that I ran into the arms of a psychiatrist colleague and friend when I was thirty-three, seventeen years after my first experience with bipolar disorder. I puzzled my colleague who put me through intense psychotherapy and prescribed medications without ever settling on a diagnosis over the ensuing three years.
I was eventually referred to another psychiatrist with a special interest in mood disorders and abundant experience in treating mentally ill physicians. After our first hour session where I talked without a break in a chaotic, pressured, and tangential manner he calmly offered me the diagnosis of mania and bipolar disorder. He offered me Lithium. I thought he was incompetent. Despite deep reservations I started the Lithium and within weeks felt the first twinges of improvement. It was to prove to be a long and difficult relationship as my disorder proved resistant to over twenty medications and intense therapy. By the time we finally found an effective regimen of medications, the centerpiece being a newly marketed anti-psychotic drug, I was fifty. But I still was able to practice medicine, stayed married, and helped raise three children however much my relationships suffered. By fifty-five I had written a book.