The first thing I did when I received a copy of the letter from the psychiatrist to my GP was to Google this strange new diagnosis; cyclothymia. I had been in the mental health services system since I was 16 with anxiety, then ‘disordered eating’ and, most recently and for the longest time, depression. Deep down, I always knew I was only ever telling GPs, therapists, counsellors, and psychiatrists half the story; it wasn’t only feeling unhappy that made me afraid of my own mind, sometimes it was being unstoppable, unsilenceable, inspired, frantic…manic.
Every result I found on Google described my experiences up until then; often undiagnosed or misidiagnosed as unipolar depression due to the fact people can make allowances in their life and ‘get by’ with the manic end of cyclothymia, alternating periods of high and low mood with no more than 6-8 weeks without any symptoms, quick temper, hypersomnia and insomnia, easily distracted, lack of concentration…..but again and again, in page after page the same word kept cropping up; “mild”.
‘Mild’ was like a kick in the teeth to me. I had gone to my GP on my knees; I had maxed out my credit cards in a 4 hour spending spree, had a pregnancy scare after unsafe, impulsive sex with a stranger, I’d been sleeping 4 hours a night and my head had been so noisy with thoughts, ideas, self-recrimination, and I had had enough. He had scribbled it all down and got me in to see a psychiatrist who prescribedanti-psychotics on top of the anti-depressants I was already taking. The anti-psychotics were like a hammer to my exhausted mind but I luxuriated in the quietness of my mind. ‘Finally!’ I thought, ‘I know what’s wrong with me; bipolar is a real illness, with real, famous sufferers who nobody blames for their inability to get out of bed some days, or stop talking on others!’ Later, finding out, on site after site, that what I was suffering was ‘mild’, and frequently undiagnosed as people with it are busy getting on with their lives rather than going to their doctors, the triumph went out of my relief; was I just weaker than all these invisible, untreated sufferers? Was it just something fundamentally unpleasant about me that meant I found it so hard to maintain relationships rather than, as had thought for a while there, the impact of dramatic and unpredictable mood changes?
Eventually though, after looking at a lot of websites, I started finding small online communities of other people with cyclothymia. They told stories that I recognised myself; alienating friends, family and partners through their unpredictable changes of mood, being unable to hold down a job or work reliably because some days depression might body slam them back onto bed when their alarm goes off or because on a manic day it’s better to drive to the other side of the country or take a short break in Europe than go into the office. They were telling each other something important; cyclothymia isn’t mild, it is a milder manifestion of bipolar symptoms. Bipolar is to cyclothymia as a rock shattered in a massive earthquake is to a rock worn down to dust by steady, reliable, constant erosion; either way it gets worn away*.
The problem with the classification of cyclothymia as a mild mood disorder is that it gives rise to any number of misconceptions about what sufferers of cyclothymia, like me, experience. Trying to explain anything about the unpredictability and disruptiveness of your moods when they are officially ‘mild’, sounds like posturing and attention seeking. My depressive periods may only last a week or two at a time, but in the middle of them I can’t see the end, and I can’t remember ever being better. My manic periods might be read by people who don’t know me so well as hyperactivitiy or enthusiasm, but they leave me exhausted, embarrassed, and frequently poorer.
And the saddest, most dangerous thing about calling cyclothymia mild is that not only do some mental health professionals not take it seriously (I was advised it would eventually become ‘full blown bipolar’ and more help would be available to me then, but to get on with things until then) but some people diagnosed with it begin to believe they are exaggerating, or overstating their troubles. I frequently remind myself that it is acceptable to shout for help when nobody is listening – that when a depressive mood takes a particularly viscous hold, or I have racing-negative thoughts, or I am so manic I can’t sit down or sleep – that those things are as real, as urgent and serious as any other manifestation of a mood disorder and I, just like everyone else with cyclothymia, deserve to be helped.
* This analogy was borrowed (with permission) from this great post
This post was originally published on the Mind blog, on Tuesday 26th March 2014 but has since been deleted in their site overhaul so the above link is via the Wayback Machine