At the end of my first date with Sara, she moved in with me.
You might think the date was extraordinary. It wasn’t. We’d gone to a Hollywood hamburger stand and gabbed about bands and writers for four hours. Until that night, we’d only spoken on the phone a few times. It didn’t matter. By the time the ice in my soda had melted, I’d fallen in love.
Sara was twenty-seven, and what people used to call a wag: smart, quick-witted, encyclopedic. She could recount every failed Everest expedition in mesmerizing detail — the sort of a talent I would expect of a rock climber, not someone who’d never gone camping. I kept wondering why no one had snapped her up. Then I found out.
“There’s something you should know about me,” she said, a couple of hours into the date. “I hope it doesn’t scare you off.”
Panicked thoughts raced through my mind. A jealous ex? An STD? I tried to remember if I’d sipped from her drink.
“I’m bipolar,” she said.
“Good,” I replied.
This was the odd humor Sara and I had already established, but I wasn’t entirely joking. I’d had several close bipolar friends, and had once been in a long-term relationship with a bipolar woman, Nyla, whom I still consider the smartest person I’d ever met. From a distance, I’d seen how much energy it took Nyla to keep her episodes under control: weekly doctor’s visits, blood tests, complicated regimens of medications.
And yet for all their problems, my bipolar buddies had always kept things interesting. Take my friend Jerome, hired one summer to drive a van full of rich and annoying European teenagers across the country. Somewhere in the Midwest, without telling the kids or his employer or anyone else where he was going, he simply got out at a gas station and walked away. “I was bored,” he told me. Irresponsible, yes, but hilarious.
I didn’t hear Sara’s story until later, but it didn’t have many funny parts. Her condition was rooted in a childhood depression that began when her father died suddenly of stomach cancer. At eighteen, she enrolled in the Ivy League university she’d dreamt of attending since childhood, and within a semester, was incapacitated by depression; she dropped out and returned to L.A. Suicide attempts followed. Then came her diagnosis, and years of experimenting with different psychiatric drugs until her doctors found the magic combination. Sidelined for years, she was finally looking forward again: doing PR for a record label and working part-time toward her bachelor’s degree.
How could you not admire such a person? When I looked at Sara, I felt inspiration, not pity. And even though I’m not the type to plunge quickly into relationships, I was convinced I was in love. I invited her back to my place. Aside from a quick trip to clean out her studio apartment a few weeks later, she never went home.
“Of the two of us,” I told her as we lay happily in bed, “I must be the crazier one.”
Nine months later I stood over her pale, unconscious body, frantically dialing 911 for the first time in my life.
You could compile an entire book of quotes comparing love to madness. But of all the psychological issues in the DSM-IV, only one really resembles the experience of love. “An illness that is unique in conferring advantage and pleasure,” writes Dr. Kay Jamison in one of the most famous memoirs of bipolar illness, An Unquiet Mind . It’s easy to confuse love with mania, Jamison says. The trouble is that love is fleeting. There’s no cure for bipolar.
The popular caricature of the disease — people swinging rapidly between happiness and sadness — isn’t the whole story. Most of us may have been unhappy enough at one time or another to recognize a fit of depression, but the other half of the disease (the mania that leads to everything from religious fervor to shopaholism to insatiable libido) is much harder to fathom. For instance, hypomania, which is a mild form of mania characterized by enviable productivity, can lead to what is called a “mixed state,” in which the bipolar individual is both miserable and energetic enough to do something about it. Before L had found an effective combination of meds, she drove halfway across the country in a mixed state, buying expensive clothes and jewelry for herself, with the goal of committing suicide when she reached California. Fortunately, her mania dissipated before she made it there.
Like such behavior, love is nonsensical. All relationships suffer from irrationality, which is why they can be particularly susceptible to the ups and downs of bipolar. The most obvious problem is the wild swings in libido: one week your partner wants sex all the time — maybe too often — and the next they’ve got the sexual impulses of a Buddhist monk. With both Nyla and Sara, I never knew what sort of response my advances would receive. And after sex, when I thought we’d both enjoyed ourselves, sometimes S would burst into tears. “What’s wrong?” I’d whisper, to which she’d cryptically reply, “I feel overwhelmed.”
Sara’s life was a constant battle against entropy. While most of us are bored by too much routine, Sara was obsessive about hers, and as her boyfriend, I found myself joining her in it. I, who have never liked TV, started watching hours of it with her every night. Infatuated with cleaning products, Sara taught me the joys of repetitive household maintenance. It took her all day to clean the bathroom, and when she was done, she would begin all over again. “It’s better than watching TV, isn’t it?” she’d say, as if these predictable tasks were the only options.
Our relationship became defined by obsessive routine, something that might normally have made me feel antsy and restless. But because Sara clung to the structure so fervently, I followed her lead. I began to drop off the social map. The parameters of our life together drew further and further inward, until we were living in a tiny, airtight box created by the quirks of her disorder. I became not only her enabler, but her progeny as well.
This probably isn’t how most people picture bipolar disorder. Yet despite this, more people than ever think they know what bipolar is — a mixed blessing for those who suffer from it. This is partially thanks to the ubiquity of advertisements for medications like Abilify and Zyprexa, and partially due to diagnoses, which have doubled over the last decade. A 1997 National Mental Health Association survey found that more than two-thirds of Americans had limited or no knowledge of the disease; almost a decade later, eight out of ten Americans think they know what bipolar disorder is. Everyone from disgraced New York Times reporter Jayson Blair to Debra LaFave, the high-school teacher convicted of seducing her fourteen-year-old student, has employed the bipolar defense. And if they don’t trumpet it as the explanation for their misdeeds, media experts are happy to do so on their behalf. Without ever having met her, Fox News contributor Dr. Keith Ablow all but diagnosed Britney Spears on air this month. “I would put on the list of possibilities a mood disorder like bipolar,” he said, further cementing it as the official catch-all for crazy people.
“There is never a story or scene with healthy, happy bipolars because even though that type comprises the bulk of the population, it doesn’t sell and isn’t exciting,” says a bipolar woman who maintains a blog about bipolar disorder called Weird Cake. “Top this off with sensational misinformation from people like Oprah, and you build a population that fears us and looks for us in dark corners.”
As a result, half of all American adults say they wouldn’t date a bipolar person. Back when I dated Sara, I wasn’t one of them. I’d read in Psychology Today that ninety percent of marriages involving a bipolar person end in divorce, but I figured that statistic applied to couples who were ill-informed about the illness, people who weren’t prepared to meet it head-on. I also ascribed the figure to reporting bias: there were plenty of people out there who were bipolar and lived drama-free lives, and thus never made it into the statistics. Yet even with everything I knew about the disorder, I still constantly discovered new challenges, as basic as figuring out who my partner really was, as mundane as whether I should say something when she started cleaning the toilet bowl for the third time in a row.
Even in the most even-keeled people, dating can be a crisis between ideality and reality. We’re constantly told that the key to successful dating is to be yourself. However, “when you have a psychiatric illness, it’s a part of you,” says a bipolar Brit who keeps a pseudonymous blog: Social Anxiety and Bipolar Diary of Annie. “You cannot tell where your personality ends and the illness begins.”
Locating this gulf between personality and illness often falls to the significant other. “I find it difficult to realize when my daydreams cross a line into unhealthy hypomania,” says Annie. “This is where I rely on my friends to put me right and stop me from getting carried away.” The role of caregiver can strain any relationship. While Sara took her meds and saw her psychiatrist faithfully, she also neglected her physical health, leaving me with the choice between watching her eat nothing but popsicles all day long, or nagging her about it.
And as anyone would, she resented it when I played nutritionist. I eventually decided the only way to preserve the relationship was to let her do what she wanted. As her physical health seemed to deteriorate, I resisted temptations to call her doctor. But according to David Oliver, I should have. Oliver, who is not a psychiatrist, runs one of the internet’s most popular sites on bipolar disorder, Bipolar Central. He launched his bipolar consulting business because he was dissatisfied with the professional care his bipolar mother received.
“There’s a huge flaw in the system,” says Oliver. “They give you fifteen minutes at the doctor, they forget to tell you there are ten to twelve different meds, or to warn you about the side effects you’re experiencing.”
That lack of professional supervision means people in relationships with bipolar individuals must step outside the normal boundaries, according to Oliver — communicating with your boyfriend’s doctor behind his back, for instance. Such actions have saved lives; they’ve also violated trust, and in the end, I found myself unable to tell where the line separating those two requirements was. “It has been my experience that some people [with a bipolar partner] use the disorder as their immunity card,” says Danielle. “Nothing in the relationship is their fault because they’re dating or married to a bipolar person.” My relationship with Sara was filled with gray areas — the popsicle issue, for instance — in which I could never figure out the right thing to do.
Which is why some bipolar people prefer to date others with the same disorder. Thirty-seven-year-old librarian James Leftwich struggled for years with relationships because of his schizoaffective disorder — essentially bipolar coupled with schizophrenia’s delusions or hallucinations. Tired of being misunderstood by a population generally unfamiliar with his condition, he created NoLongerLonely.com, one of the few dating websites for the mentally ill. In four years, he says, the site has helped produce countless relationships and at least six marriages. But even for someone with a similar illness, another person’s mental health is not an easy thing to be responsible for, and Leftwich says even he isn’t sure he would use his own website right now. “Personally, I’m in a frame of mind where I’m not sure I want someone with a mental illness,” he says.
On the other hand, an issue like bipolar disorder may encourage a healthy sense of compassion. When twenty-eight-year-old software engineer Jil told her husband about her illness on their very first date, she was happy that he seemed a little bewildered and had lots of questions — it meant he cared. “I also wanted to be a better person because of him, and when I feel no other reason to swallow those pills that stabilize my mood, I do it for his sake, not just my own,” says Jil.
It was a sunny Saturday morning. Just a few minutes earlier I’d been lying on the couch, reading one of the self-help books Sara had given me to help ease us through our crumbling relationship. Then, without warning, she stumbled out of the bathroom and collapsed on the floor. I think I would have lost it had she not regained consciousness a minute or so later, or if the paramedics had not arrived as quickly as they did. After I gave them the names of Sara’s medications and watched them load her into the ambulance, I called her mother, a woman I’d only spoken to a few times. She received the news almost serenely. It wasn’t the first time her daughter had been whisked off to the hospital.
Sara’s wasn’t an overdose, or a suicide attempt — at least, not an overt one. I’d known Sara was severely anemic, that her pills had made her stomach bleed. For months I’d asked her what her doctors were doing about it, and she’d given me cheerful answers about iron infusions and blood transplants. I no longer believed her, but I wasn’t sure what I was supposed to do. I researched her medications and learned all sorts of frightening things. One of them wasn’t even indicated for her disorder; it was an epilepsy medication that the drug companies encouraged psychiatrists to use off-label.
But it was difficult for me to voice my reservations about her care. Sara liked hospitals. She loved Scrubs. She admired doctors, detested any criticism of the medical system, and talked about her psychiatrist as if he were a best friend. When she spent a night at a sleep-study clinic (she thought she was narcoleptic), she talked about it as if it were a slumber party. She kept getting into fender benders from falling asleep on the freeway, yet still insisted on driving to volunteer at the hospital that had saved her after her suicide attempt. It was more than simple gratitude, she admitted; the hospital’s rituals made her feel safe and comfortable. She talked about it the way other people talk about visiting their grandparents.
When I told Sara what I’d learned about her medications, she told me she would rather die than get off of them, and pointed out that she knew the cost of them better than I did. She couldn’t remember words, for instance — she who had wanted to be a writer. But those pills had given her a reason to live. Did I know better than her doctors did? No, I supposed I didn’t. I knew that for us to have a healthy relationship, though, I needed to trust her. The trouble was, I no longer did. At that moment, I decided I couldn’t stay with Sara any longer.
That day, when I got to the hospital, I found her looking happier than I’d ever seen her. I was baffled. Five minutes earlier the doctor had informed us that her life was in danger if she didn’t find some way to fix her anemia. But she seemed at peace now. That was the worst part about it — in her hospital gown, sitting up on her austere gurney bed, she looked as if she were finally at home.
I have my own theory about relationships with the bipolar: the successful ones are those in which the relationship simply isn’t in competition with the disease. Sara seemed to regard the illness as a more intimate part of her than I could ever understand — not just a profoundly affecting experience, the way other serious diseases are, but almost the entire essence of her existence. In the end, I simply wanted there to be more.
