Rockville psychiatrist Norman Rosenthal is a top expert on seasonal affective disorder, which about 5 percent of Americans suffer from. Photograph by Matthew Worden.
Solving the Puzzle
No matter what the approach, it takes time to feel better. What works for one person may not work for another.
“With mental illness, sometimes you need more pieces of the puzzle before someone can figure out what’s going on,” Meredith says. She visited eight doctors before receiving a diagnosis of bipolar disorder.
At first, everyone viewed her symptoms too narrowly: “One doctor was interested in my fear of being sick. He thought I had OCD, so he put me on OCD medication. Someone else wanted to look at the depression and put me on an antidepressant. I felt like an idiot. It was sort of like going to a doctor and saying, ‘Look, I’ve got this big thing on my arm,’ and they’d say, ‘It’s nothing.’ You’re like, ‘Really? Because it hurts and it doesn’t feel right.’
“It’s hard to confront doctors,” Meredith says. “They’re educated. They’re writing notes about you. But you have to trust yourself enough to know when the fit is right.”
A former nurse, Meredith found her current psychiatrist through a friend in the medical profession. This doctor spotted the telltale ups and downs of bipolar disorder, wrote a prescription, and assigned a therapist. Things began looking up, but the work isn’t finished.
Thanks to greater public awareness, those experiencing mental illness for the first time may stand a better chance of finding help quickly.
“I’m jealous of people who are having their first depressive episode in this day and age, with the media talking about depression and the fact that there is such a prevalence of information about drugs,” Betty says. “It took me a good ten years from college before somebody handed me a pill.”
These days, Betty and Meredith are focused on figuring out what “normal” looks and feels like. Says Meredith: “With mania, you have no filter, so things you say to people are not things you should say.”
Then there’s the grieving process. This involves letting go of one’s yearning for a mild form of mania, called hypomania, that’s characteristic of early episodes.
“It’s a completely natural high,” Meredith says. “You don’t need any sleep. You feel great about yourself and about the world. You get so much done. You don’t take things personally. It’s truly an ideal way to be except that you’re pretty self-absorbed, so it’s hard to maintain relationships.
“I’ve spent the last two months mourning the idea that if I stay on my medicines I won’t have that again—even though it’s not real.”
And stay on her medicines she must. Bipolar sufferers must remain medicated for life. Likewise, patients who have experienced three or more depressions are thought to need medication indefinitely. Those suffering from their first or second depressive episode may eventually live drug-free, and people with mild depression may be able to recover with talk therapy alone.
A prescription of lifelong treatment can be difficult, especially because many mental illnesses are first diagnosed when patients are in their teens or twenties.
“It’s not consistent with how they see their lives going,” Akil says. “That’s understandable, but unfortunately the medicine is necessary.”
Akil and Hookman stress that mood and anxiety disorders are illnesses with an underlying biological basis. Episodes are triggered either by physiological changes, such as hormone surges associated with pregnancy, or by life events, such as a divorce or death in the family, but they may also arise when there’s no identifiable stressor.
Both Betty and Meredith are coming to terms with the reality of their illnesses.
Says Betty: “I do not anticipate a time when I would be without some type of help, be it a drug or some type of therapy. It’s just like having diabetes or heart disease. I’m going to do what I have to do.”