“Coming Out” as Mentally Ill – the psychiatric Catch-22

c22If you enjoy black humor or satire, you’ve probably read Joseph Heller‘s classic “Catch-22“.  Published in 1961, it describes the paradox of a situation that is contradicted by its very nature.  In the story a soldier wants a doctor to declare him unfit, because he does not want to fight.  The problem is that anyone who wants to fight is insane, and so by definition is “unfit”.  If you do not wish to fight, then clearly you’re sane, and “fit for duty”.

These days, “Catch-22” has expanded to cover just about any no-win scenario.  In the case of the mentally ill, one of the basic questions every person diagnosed must face is “do I tell anyone?”

prideAnother commonly used phrase in pop culture is “coming out”.  Usually it is applied to someone who’s gay.  If they don’t tell anyone, they’re “in the closet” and subject to a great deal of speculation, along with a fair amount of contempt.  However, if they “come out”, let the world know they’re gay, the inevitable reaction from many becomes “why don’t they keep that sort of thing to themselves?  Why involve “normal” people?  Who cares?”   Catch-22.

Applied to the mentally ill, it’s even worse.  Currently there is a strong push toward social acceptance in the LGBT community (Hurray!!).  There is a determined support network out there that refuses to be denied.  But among the mentally ill, while there is a support network, there is only a very limited attempt to raise awareness.  Usually it’s only temporary until the next crisis comes along.

6032ed90_01-its-a-secretFor the first several years after my diagnosis I made a determined effort not to tell a soul outside my immediate family and circle of friends.  It was our “dirty little secret”.  Of course anyone who knew me even in passing understood there was something “not right” about me.  I just wasn’t “all there”.  It was acknowledged, but never openly discussed.  I was “just that way”.

I can’t remember making a conscious decision to “come out”.  I do remember being very frightened to say “I’m bipolar” out loud.  But at the time it seemed the best of bad options.  Do I let people continue to talk about me behind my back?  Or do I take the bull by the horns and essentially say “Yes.  I’m crazy.  I have a chemical imbalance that affects my brain, which in turn affects my behavior.  This is who I am.”?

bipIf I never admitted it, it does not give society permission to address it either.  Even though people would talk behind my back, no one said anything to me directly.  I used to think that was easier.  But by saying “I’m bipolar.  I’m trying to deal with it.  If you’re in my life then do the same” I took a small measure of control.  It opened up opportunities for dialogue.  I don’t feel ashamed of what I am anymore.  I’m not bad.  I’m sick.  BIG difference.

However, there’s an unexpected downside to this public announcement.  By making it known I’m mentally ill, it gives people permission to speak freely.  Sometimes they forget that even though they can now talk about the illness in my presence, that does not make it any easier for me to deal with.  At first, when I started talking about it, it opened a dam.  I heard a veritable flood of stories that usually started with “Remember when you…” followed by a vivid description of my irrational behavior, accompanied by much laughter and eye-rolling.  Guys, I appreciate that you’re still in my life.  Thank you.  And I’m glad you can let off a little steam.  But… I’m still in the room, ok?  And I’m not cured.  I never will be.  So please think before you speak.  Let’s take this in small steps.

blue_meanie_chief_and_jeremy_by_mothmanboris-d4bd4g0While “normal” people can lose their temper or become frustrated, when I do it It’s often cause of immediate alarm – I’m “acting out”.  Err, no, at least not always.  Sometimes, yes.  But at times I’m just frustrated.  The world is an ugly place and sometimes I want to jump up and down like the proverbial Blue Meanie.  Now everything I do is subject to intense scrutiny. Is my behavior due to a manic phase?  A depressive phase?  Should I adjust my meds?  Should I call a doctor?  Which, of course, just adds to the frustration.  Arg.  In addition, the people who have dealt with me longest now have their own set of coping issues.  Being the support network to an out of control mental illness is #1 on the list of noble but thankless tasks.  So a bit of overreaction is to be expected.  Unfortunately, again, because of my illness, I’m not in the best position to deal with their overreaction of my reaction.  But I’m trying, and thank heavens so are they.

Another unexpected paradox is in the medical profession.  If I’m meeting a new doctor (my life is a constant succession of doctors) I’ll be very frank with them – here’s my diagnosis, here’s what it means, if you have questions ask.  Even though they’re doctors, unless they’re in psychiatry they probably don’t know how to deal with a bipolar patient.  Most are relieved I’m so up front about it, and many ask me questions not only about how I’ll react to something, but just how to address a bipolar patient in general.  Though we’re all different (of course), hopefully I can at least offer some insight – that’s cool.

The downside is that doctors can use this information like a weapon.  In my last blog post I wrote about how I was taken away in handcuffs early one morning because of this.  It has happened to me with medical doctors as well.  The latest incident was during a trip to a local Emergency Room.  Before I realized that the degenerative disc disease had spread to my neck, I wasn’t sure what was causing the blinding pain.  I felt as though I’d been shot through the shoulder, and it never stopped.  My doctor told me to go to the ER and get an MRI.  Ok.  I went to the ER and I described my symptoms.  I also, as usual, mentioned I’m bipolar.  This normally aids in communication.  When they asked me to describe the level of pain I was in from 1-10 I replied “11.  It’s so bad I could kill myself.”

3qedboNow, normally either they’d blow that off as hyperbole (which it was) or think it was a stupid joke to try to ease an otherwise tense situation (which it was).  But because I’ve admitted I’m bipolar, this team decided to inform me that any further statements of that kind would result in a one-way ticket to the nearest secure facility where I would be put on an involuntary 3 day psychiatric hold.  Then I was asked formally if I wished to revise my statement.  Grinding my teeth I simply said “my shoulder hurts”.

I understand their reaction.  In the days of happy-go-lucky lawsuits they have to be careful.  But guys, the knee-jerk automatic response isn’t required either.  A little common sense goes a long way.  Like – you could have just asked if I was kidding around.  And yes, I agree, under the circumstances I selected my words poorly.  I was attempting to describe the worst pain I’ve felt in my life, I wanted them to know I wasn’t wasting their time by being there.  I wanted the damn MRI.  Instead I was told they weren’t going to give me any painkillers of any kind (did I ask for any?  No.) and that I should return to my doctor.  If she thought I needed an MRI she could schedule one.


I don’t have a good solution to this.  Because my behavior affects every relationship I have, I maintain that telling people up front is a good idea if I’m going to spend time with them.  But some people do get weird about it.  Saddled with my own weirdness I’m not in the best position to help them deal with theirs.

And so it goes.