Am I sick?

“Do you think you are sick?”

My outpatient shrink asked me that at my first visit.

It’s an interesting question, loaded with potential implications.  I don’t view bipolar disorder as me.  It’s not a huge part of my life.  I just have a label.  A diagnosis.  And since it’s not manifesting itself in any way, I am not currently sick.  I just happen to take a pill every day to keep it away – almost as a preventative measure, rather than as a treatment.

Despite being diagnosed with bipolar 1 (the supposedly more “severe” version), I don’t always identify as someone with mental illness.  At least not on a day-to-day basis.  In the middle of an episode? Perhaps.  I think that’s why I have a hard time relating to many of the people on popular bipolar and depression forums such as Reddit, even though we have the same disease.  Some of that is certainly self-selection.  People who are more ill may be more likely to browse these forums for support, at least compared to people who are stable.

I think for some people, bipolar disorder is part of their identity.  In other words, the ups and downs are part of who they are.  In the arts professions, there is this thought that bipolar-ness contributes to their work, and that their creativity stems from this disorder.  I think this is a very valid point.

However, I feel the opposite.  I see my “manias/hypomanias” and “depressions” as manifestations of the illness, but when I’m euthymic, I consider myself well or not sick.  I know most doctors believe that bipolar disorder is a chronic illness, and that it can’t be cured – that it can only go into remission and requires maintenance medications for the rest of one’s life.  In other words, forever sick. With the huge caveat that I’m not a psychiatrist or psychologist, I’m not sure if I entirely subscribe to that.

Think about it.  Unipolar depression isn’t necessarily viewed as a chronic illness (though for some people it is and they do stay on anti-depressants forever).  We don’t know enough about the biology of depression and bipolar disorder to know if they are mechanistically on the same spectrum, but there is often genetic links based on family history or genome sequencing.  So what’s to say bipolar disorder is any different?  Most of us have more depressive episodes than manic episodes anyway.

So back to the doctor’s question – are you sick?  I wonder what the purpose or intent of the question was, and I wish I had thought to ask.  Was it to see how exactly how I viewed my illness? If it was a part of my identity?  Or was it to ask if I was currently sick and having symptoms? Or was it to determine if I have anosognosia and don’t believe I have bipolar disorder at all?

Regardless, I answered that although I have an illness I don’t see myself as sick and yes, I take my pills every day (or at least try to). I hope I got the point across 🙂

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