I have bipolar vs I am bipolar

I have seen people say 'I have bipolar' and others say 'I am bipolar.' Is it just semantics?

Or is 'I am' identity language? For example, I could say, 'I am a woman,' and 'I am a Kiwi (New Zealander)' and 'I am a mother' and 'I am an artist' (even though I'm a 'hobby' artist not a 'professional'). I could say 'I am a merchandiser' (working part-time helps my self-esteem).

 
I say 'I have bipolar disorder,' not 'I am bipolar.' I also say 'I have PTSD (post-traumatic stress disorder)' and 'I have social anxiety.' Not to every single person I meet, but where I feel it is relevant to mention it. I don't say 'I am PTSD and I am anxiety,' because these are conditions I have that I'd prefer not to have because they have caused me immense suffering.

When I was very unwell (and my psychiatrist said in frustration, "I'm doing my best to keep you alive right now,") it would have been accurate for me to say, 'I am suffering from bipolar disorder and PTSD and I am struggling with social anxiety.'

At other times when I feel considerably better, I could say, 'I live with bipolar disorder and PTSD,' even though I still have a chronic illness (bipolar) and trauma injury (PTSD), which could depending on the level of impairment be considered to be disabilities. I am still not able to work full-time because of my 'disorders.' Here in New Zealand, my level of impairment is still considered to be a 'disability.'

When I started this blog, I weighed up whether to include 'bipolar' in the title. I didn't want to for bipolar to define me. I also wanted to write about how anxiety and PTSD affects me, not just bipolar. The main reason for blogging is that I want to reduce stigma. I have experienced stigma for over 25 years. I was told I was demon-possessed before I was diagnosed with clinical depression (a diagnosis I had until it was changed to bipolar 1 in my forties after rejecting a diagnosis in my twenties - because I didn't understand it and I had unpleasant side effects to the medications. I rejected it when diagnosed again because of that bad experience and because of stigma). 

I am now on medications for bipolar and I am having therapy for PTSD. I was just about to write 'My bipolar is....' So I guess I do consider bipolar and PTSD and anxiety to be part of my identity, something that is mine. I think because I now accept and own and manage my diagnoses rather than reject them and have them spiral out of control. I even rejected anxiety at first because of indoctrination about any form of relaxation exercises being 'demonic' (which then made me even more anxious). My experience with bipolar, PTSD and anxiety may be similar yet different to others with a similar diagnosis.

I've seen arguments about language use for example with 'autistic person' versus 'person with autism.' Some people argue that being autistic is their identity and without it they wouldn't be who they are. Some people argue that autism is neurodiversity (normal variation of cognitive experience of brains in the human population, not needing  a 'cure' and wanting the word 'disorder' dropped from 'autism spectrum disorder'.)  

Some people include bipolar as neurodiversity, saying that it is a brain wiring difference that should be celebrated (and that research is not needed). Some people with bipolar disorder and similar conditions will be unsure if they would be the same person without their disorder(s). Even when my mood is more 'stable', I am frequently told I am 'different'. I was told several years ago by both a psychiatrist and a psychologist in Australia that I 'had Asperger's' (which has since been incorporated into part of the autistic spectrum). I asked for a diagnosis in writing, and they told me that it was pointless because I am an adult (diagnosis was geared towards children for special accomodations in school). Plus they said there was stigma. 

I have sensory issues, difficulty making eye contact, have difficulties in social situations, have times when I've been mute and I 'stim' and I was told I saw things too literally and too much in 'black and white' and that I was 'too honest'. I thought autism explained how I was. But then when I was hospitalised during a 'breakdown' (rocking to self-soothe myself in extreme distress), all they could see was bipolar and they said they couldn't see autism, so I was confused. In New Zealand, I had bipolar reconfirmed by another psychiatrist (after a manic episode because I had gone off meds because I couldn't tolerate the side effects and I didn't believe I was bipolar). Even then, I was deeply suspicious of psychiatrists and other doctors and found it difficult to accept the diagnosis. Mainly because of stigma.

I had a formal autism assessment. I was told that I do have autistic-like traits, but they ruled out autism because a diagnosis of bipolar 1 disorder, PTSD and social anxiety disorder was a better fit. I already knew I was suffering from PTSD (I changed my name to try to stop the flashbacks of trauma whenever anyone said my former name) so that diagnosis was not a surprise. I was told that it is very rare to make a diagnosis of autism in an adult because it is considered to be a childhood disorder. My sensory issues were attributed to PTSD, my fleeting eye contact and avoidance to PTSD and social anxiety. My seeing patterns in everything to bipolar. My stimming to anxiety and also grounding myself when I dissociate with PTSD.

​I could be appropriately social in situations where I felt safe, so it was not affecting me all the time, therefore an autism diagnosis did not fit. They said that if they give me a diagnosis of autism, then I would be unlikely to be approved for trauma therapy for PTSD, so it was 'better' that I didn't have a formal diagnosis of autism (because autism was seen as more of a quirk and not needing treatment). I was told that childhood trauma changes brain development, which is why I am always hypervigilant because I am on constant alert for danger. So yes my brain is 'different', and it has been attributed to both genetic and environmental factors. 

There is no 'cure' for bipolar, PTSD and social anxiety. These conditions can be managed. I take medication for bipolar and am currently having trauma therapy for PTSD. I have learned coping skills for social anxiety and I have medication as necessary for times when those coping skills are not enough. Medication is like using insulin to manage diabetes. It's a daily reminder of actions I need to try to stay well. My self-care includes creative outlets and trying to remember to breathe.

As for neurodiversity - advocates reject the medical model. I did for a while and I became very, very unwell. Yes, my brain is 'different' even when I'm more 'stable' with my moods, but I still need help with therapy and medications. Otherwise, I'd be dead by now.

Many advocates of neurodiversity are fearful of research, claiming it will be used as a form of eugenics and that the disability is caused by society. I am all for research to help people access more effective treatments. Stigma is harmful, yet I have had immense suffering from my conditions organically. The suicide rate for bipolar is high and I don't think it's just from stigma. Some recent research shows that autism, bipolar and schizophrenia have shared gene expression patterns in the brain.

My conditions vary in how much they impact me. Sometimes I have been affected so severely that I have been hospitalised. Sometimes I could not work at all. I found it very difficult to work full-time and after more trauma, I am still unable to work full-time. Quite often my brain is so overwhelmed that I 'shut down' (attributed to PTSD and anxiety). During episodes my brain becomes so disorganised, I am unable to do any 'normal' everyday tasks. My short-term memory becomes so extremely impaired that I cannot remember what day of the week it is or if I just took my meds. Most of the time, I am alone because I don't feel safe with most other people. My energy levels fluctuate. I work with flexible hours because I am unable to get up at set times in the morning. At other times, I seem to function reasonably well - enough to mask my anxiety and to work part-time and to hold occasional conversations. Enough to look (almost) 'normal'.

Having some meaningful projects to gradually work on gives me a sense of meaning and purpose. Blogging is a way of quietly advocating about mental health. When I can, here and there. If it helps someone understand more and to have more empathy for others and it reduces the stigma, then that is what I want to achieve with it. Plus having a voice is very important to me.  

Would I be the same person without my mental health conditions? Yes and no. I think I have perhaps developed more empathy than I had previously because of my struggles. I see the world less in black and white and now see colour, which I like to express in my artwork. I would like to think I would still be creative without bipolar. I have found out just how determined I am to not only survive but to somehow thrive. With therapy, it is hoped that the effects of the PTSD will be reduced. That my brain will have more 'capacity' for more ordinary things - like living independently, like most people can. 
​
Little by little, I will move forward. I am not bipolar, I am not PTSD, I am not anxiety. I am Xanthe. I am me.

A doctor criticises the neurodiversity paradigm as being well-intentioned but failing people who are mentally ill:  
https://www.psychologytoday.com/us/blog/freud-fluoxetine/201807/the-problem-the-neurodiversity-paradigm