An Open Letter to My Bipolar Disorder

The worries of my youth and I need a to have a frank talk.

I first learned about you as a recurring character when I was 16. I went to see a psychiatrist. You were news to me, then. We were stuck together.

I should apologize. I avoided you. I spent years building my life around fear. It was easier to think that you, bipolar disorder, were a villain. You could be controlled, tamed but never, ever, made peace with.

This was childish. In fairness, I was a child.

I remember the first speeding ticket, 75 in a 25. The first kiss I didn’t mean. The first night without sleep. The train tracks at 4 am. There are attitudes of others that would have been good to understand. You had lessons to teach.

Some will be uncomfortable with your grandiosity. Some will be drawn to it. I met my wife while a little “up”—thanks for that. Some people won’t keep up with your flight of ideas. I was one of those left scrambling to keep pace!

The energy, I might have been forewarned, is addictive. How much energy you filled me with and how much I could accomplish are unrelated. An unfortunate consequence of wanting to accomplish? The very drive to do so comes at the cost of never feeling like it’s done.

Anhedonia can visit triumph as easily as failure. An accomplishment is a fact, like the duration of a second—not a feeling about it.

When it comes to the expertise I built about you—that was, in the end, mostly done without your help. I became a consummate consumer of your biology, treatment, and phenomenology. I will admit I was ashamed to publish about you academically. It’s more comfortable being an expert in other people’s problems! I was ashamed, and even this letter is one which I feel uneasy about.

When the autoimmune illness—I probably had all along—announced itself, after three rounds of streptococcal infection in my mid-30s, small islands of red rash covered my body. A reason things had been so difficult, at least possibly, began to make sense.

My bipolar disorder and my “chronic tendonitis” had the same age of onset. The tendon pain was not best explained by overuse. I later learned of enthesitis, the inflammation at the site of ligament insertion onto bone… bilateral plantar fasciitis, chronic hand pain, pelvic floor dysfunction, and intermittent back pain, all of which began to make sense. It turns out that bipolar disorder and inflammation have some very similar biology.

A lot of my life had been built around avoiding you. I made decisions like English kings built castles—theoretically strategic. In practice, the kind of aggressively fixed decision-making that can’t keep up with a changing reality. I wasn’t going to build walls thick enough to protect myself from bipolar disorder. It was never going to work.

And you, dear bipolar disorder, was not destined to be my biggest problem. Other illnesses would follow. Psoriatic arthritis leaves me fatigued and in pain. Restless leg syndrome left me bereft of the ability to get an easy night’s sleep. I thought I was dependent on medication for bipolar disorder—with some grumpiness about that, until the ability to tolerate some of them was taken away from me. And to think—I complained about medicines that worked! With restless leg syndrome, none of those easy answers remained—I could not tolerate the medications that helped. This led me to better solutions in my research.

Deep Transcranial magnetic stimulation (dTMS) was a life-saving treatment for me starting in 2015. I received this treatment from my doctor, and in 2017, I got a dTMS machine for my own practice, and started treating others with this approach. But, like Dr. McMullen, who treated me, patients who had more than just major depressive disorder came to see me for help. I developed a novel dTMS protocol for bipolar disorder. This is a little bit like going through the looking glass, but it wouldn't have been possible without you.

Bipolar disorder, you threatened me…I thought. There were myriad hazards: I wasn’t forewarned about stalkers. Nobody told me about private equity taking over healthcare, and my ability to heal is subject to the balance sheets of vampires.

I didn’t imagine having children, much less twins. The doctor advising us to consider aborting one to save the other was a shock.

I thought depression was horrific. Now, don’t get me wrong, it isn’t good. But the actual loss of my father and sister within a month? Bipolar depression could never keep up.

Everyone’s life is a fixed number of seconds long. Not because you might take your life any day, but because it might be taken from you. My father’s last words were, “I have no regrets.” Words to live by.

—Owen Scott Muir, M.D.