engines half, straight ahead

As I mentioned in my overlong post about my bipolar disorder, the treatment plan informed by my new diagnosis is working quite well. Well enough, in fact, that I was able to give a short talk at the amazing CUSEC conference last week. That success was a major milestone for me, and a proof point that I was doing as well as I had hoped.

So this week, I’m going to be working half-time from the office (mornings), as I build a better structure to some parts of my life, and generally rebuild my brain strength. I still have some days with more anxiety than is usual or healthy, I still cry a little easily (like a bit while writing this post), and my stamina for difficult or frustrating work is about half of where I need it to get back to it. But hot damn, I can work again, and it feels fantastic.

I can’t write about my recovery without mentioning the support that’s made it possible. If someone dear to you is suffering with mental illness, know that your help and support — even just words of well wishing — can literally change their life.

or bpd2 to its friends

For almost 20 years I thought I “just” had depression: monopolar, occasional major episodes. I was well-known in my circle of friends for crying at weddings and in movies. (There is video of my convocation address at Seneca a couple of years ago that I still don’t have the courage to post — in spite of very flattering requests — during which I blubbered like a toddler with a skinned knee.) I was on anti-depressants, and they took the edge off well enough I guess. I didn’t realize that I was also suffering from a lot of anxiety, because it was my baseline. In 1993 I was off of school for a couple of months, and in 2000 I was off of work for about 2 months. Winter was the worst, Christmas the worst of the winter.

For the last 3-4 years, I thought I had ADHD. A doctor told me so! Sure had the focus and procrastination issues, as anyone who has spent 15 minutes with me can attest.

Here’s the thing about mental health diagnoses: with a few exceptions, you are a bunch of blind guys feeling up an elephant. There aren’t blood tests; the brain scan stuff is still really immature. The diagnoses are really tautological descriptions of symptoms, and if it impairs your life it’s a Condition. Some of the diagnostic criteria are such that, by definition, you can never get better: if you’ve ever had the episodes it describes, you have the condition. 21st century psychiatry, ladies and gentlemen. If you have symptoms that overlap with the area of focus of your doctor, you are pretty much going to draw that card. Other issues are probably just co-morbid, a delightful medical word for “also”, or you might not even mention them if they’re not solicited in the right way.

I don’t mean to demean the work psychiatrists do — they have done some great work on me! — but it’s clear that there are some pretty significant limitations.

So what do you do in the absence of a clear test for something? Well, when it comes to a diagnosis, I care about it to the extent that it directs us towards effective treatment. (Us, almost always — if I’m not working with a doctor, I’m damned sure working with my wife.) And it should explain a meaningful number of symptoms, like back-testing a model of any other system. I like long walks on the beach and evidence-based medicine.

I have the good fortune to have found a doctor in the Bay Area with very broad clinical range, in both diagnosis and treatment. In her opinion, ADHD was a “soft call”, and I am a pretty textbook case of bipolar disorder, probably type 2.

Bipolar disorder is ups and downs, to the point that they interfere with functioning rather than just being part of the normal ebb and flow of life: severe depression and moderate-to-severe mania. It used to be called “manic depressive”, but apparently that name had a stigma, so they started using a phrase with the word “disorder” in it. Well-played. The main difference between type 1 and type 2 is the severity of the mania. I joke that BPD1 is “why isn’t shaver wearing pants?” rather than BPD2′s “why did shaver stay up for 3 nights writing that code?”, but if you are living with BPD1 in that form it is categorically not a joke. On the other hand, if having a mental illness doesn’t let you make jokes like that, why even bother having one? Anyway, since the Type 1 vs. Type 2 distinction can be related to duration of manic episodes, or their severity, or having mixed episodes, I could probably also be classified as Type 1 (I get mixed episodes, and I’ve had week-long hypomanic periods). Most of the difference in treatment seems to relate to how careful to be about triggering a (hypo)manic episode, and we’re not too worried about that, so Type 2 is the guideline of the day.

BPD2, then, is “bad depression with periods of awesome”. Seriously, the hypomanic (mild) episodes are fantastic, and mine are not hall-of-fame episodes. Apparently there are drugs that can make you feel like that, and I’m glad I didn’t know that when I was growing up. Like “Roger” in Ben Horowitz’s story of “the flake”, I had made some great stuff happen in that state. Being treated effectively for the depression part may mean that I give up the episodes of awesome. That sucks, and it’s a bit scary, and if I weren’t badly depressed I would probably not have been willing to start a course of treatment that could mute or eliminate them. You can have both mania and depression at the same time, called a mixed episode, and I’ve had them, including for part of this little adventure. That is some confusing shit right there: you feel driven to DO SOMETHING, but have no actual energy or motivation; fatigued without being able to sleep much; incredibly distracted and irritable; very likely to keep buying games during Steam sales without ever satisfying the novelty craving. The last one may not be in DSM-IV.

BPD2 + maybe an anxiety disorder (“but just living with BPD2 can cause a lot of anxiety, so let’s wait and see”) would explain not only what I’ve lived with but also how it’s been arranged in my life. But the test is in the treatment effectiveness, because boy is that not a vanity label.

On that front, the diagnosis is a home run in overtime for a 6 from the Russian judge. Though holy-shit-this-can-stop-any-time and so forth, and it has been SEVERAL EARTH WEEKS since I could work, my improvement has been the fastest I’ve ever experienced, and the broadest. For the first time since I was…10? I am sometimes waking up without a tight-band-across-the-chest weight of anxiety. I feel like an idiot saying it, but I thought that was pretty much normal for 20 years. I’m at the point now where, during previous severe episodes, I returned completely to work. That proved to be a horrible idea, but also took at least twice as long as is did this time to reach that “I could play hurt” state.

Adjusting to this knowledge about myself hasn’t been easy. As part of the initial treatment, I’m taking a drug known as an “atypical antipsychotic”. I do not like the sound of that phrase AT ALL. Bipolar disorder is one of the 3 major conditions — along with schizophrenia and ADHD — that modern psychiatry has found really needs medication as part of effective management, so I am probably signing up for a lifetime of “mood stabilizers” — another phrase that has a little too much of both A Brave New World and Arkham Asylum for my tastes.

Here’s the thing, though, about BPD2: I know I can live a full life with it, because I have been. This isn’t something I just contracted, it’s something I’ve just discovered, and that knowledge seems a lot like power right now.

Unless I chicken out, I’m going to keep writing about how it goes, in part because it’s oddly cathartic, in part because it will have me actually keeping track of things, and in part because I wish there’d been something like this for me to read when I was a teenager, and then an adult, trying to dodge the traffic of my brain.

making progress

[I wrote most of this a little while ago, and then remembered/found it yesterday, so the timeline is a little weird.]

Several weeks ago, I stopped working because, put simply, I was not able to work. My depression had gone right through its usual winter intensification, and all the way to basically rendering me non-functional. I was unable to muster the energy, or usually even the motivation, to start to get better, and even once I was no longer able to work it took me several days to go through the process of finding a doctor to work with. Merely digging up my phone and telling people that I wasn’t going to work was such effort that I would literally collapse crying after.

For a couple of weeks, I didn’t enjoy. I didn’t enjoy playing with my daughter. I didn’t enjoy eating good food. I didn’t enjoy reading, playing old video games, playing new video games or chatting with my friends. (As my Steam friends will know, I really tried pretty hard with the new video games.) It was easy to give up alcohol as part of my treatment, because I didn’t really take much pleasure in it anyway. There was never a feeling of accomplishment or progress, even when I intellectually knew that I’d done something, or that I was taking the right steps.

I was ashamed: ashamed that I couldn’t function as well as those around me, that I had let my condition progress this far, that I was letting down the people I work with and the people I love. I was afraid that I would feel like that for the rest of my life, though I could make myself not think that if I got lucky on a given day, and I would cling to the remembrance of the thought of a feeling like the sickeningly cliched liferaft of all depression analogies. It hurt so much that I’m crying a bit as I sit on a plane and write this.

Kinda sucked; I can’t in good conscience recommend it.

Since then, I have been fortunate to learn more about myself and how to take care of myself, with the help of an incredible network of support. I’m the luckiest person ever to feel crushing despair, of that I am certain.

Getting better has been hard, it has hurt, and it I know that there are people reading this who are going through the same pain, or a pain like it only in degree. More still have a friend or loved one who suffers this way, or who they fear might. I know this because people I don’t know — and even people I do, for whom it’s even harder — have been brave and kind enough to share their empathetic encouragement. You have done me the most solid of solids, and I hope to never have the opportunity to repay it in kind. I’ll see being able to write proper thank yous as an important milestone in getting better.

I’m good at what I do: technologist, father, friend, husband, manager, competitor, entertainer. When I am at my best, I can be great. I’m going to be that again, and I can feel (feel, a major upgrade from “think”) it starting to happen. Sometimes when I cycle back a bit, or when I juxtapose how little energy I have against how hard it’s been to get back to this state, I get discouraged. But I have a lot to look forward to, and I don’t plan to squander the blind, stupid luck that has gifted me with such a helpful community.

Right now, I measure my improvement by how long I can sustain energy and “be normal”. It’s stupid and probably a bit self-destructive, but I have a lot of practice at it. (You can’t keep me from doing it, so make the most of the energy you get from me, and try not to judge me too harshly when I turn into an exhausted asshole without much notice.)

I have a mental illness that will be a part of me forever. We believe that it’s called bipolar disorder (type 2), and I still find it a bit scary. I’m still learning about it, but I also have a lifetime of experience with it that I’m mining for lessons and strategies and even hope. I have a lot more to say about BPD2, and I hope I’ll have the strength to say it, because it will help me a lot and maybe help some other people a little. I sure don’t have the energy for it right now.

I’m going to get better. I’m going to be fine. Thank you all for helping me do that, and thank you for your patience.

PSA: If you aren’t sure you’re going to get better, please tell someone. Practice saying “I’m depressed, I need help” in the mirror until you can blurt it out to a loved one or a co-worker. If you’re in the Bay Area, and you don’t know how to find a doctor, use mine, or go to a hospital or walk-in. (My doctor is fantastic, and I am going to miss how fantastic she is when I go back to Toronto.) You can heal; you can actually be better than ever.

out of service

I suffer from depression, and some related issues like anxiety. I was first treated for it in high school, though my condition predates that treatment by some unknown amount. Since that time, I’ve had varying success managing that aspect of myself, but most of the time I can keep it from interfering much with my personal and professional life.

The severity of my condition varies, and lately it has varied…against me. I’m not really functional, due to a combination of random-onset crying, incredible fatigue, (even for me) very high distractability, and virtually no motivation or enjoyment of my usual pleasures and rewards. Because of this, I’m taking some time off work to recover, and during that period Damon Sicore will be assuming my duties. I have complete confidence in Damon, and knowing that he’ll be ably running things is a source of no small comfort.

I am 100% certain that I’m going to be OK. I’ve been through episodes like this before — though it’s been perhaps a decade since the last one of this severity — and I have always come out the other side with a better understanding of myself and improvements to my life. I am intellectually optimistic, even if my emotional state doesn’t often match these days. I could not wish for a more supportive family, circle of friends, and set of co-workers. I’m truly touched by the kind notes and words from so many people already, even though I know that my absence will make their lives harder for a while.

I’m writing about this in some detail because my absence will affect a fair number of people in the project and community; because I want to encourage everyone to help Damon sort out the things I’ve dumped on him; and especially because I think that people don’t talk about mental illness enough. If we could discuss mental illness with the same candor as we do our diets, food allergies, back pain, or diabetes, I think that it would be much easier for people to get the help they need. It is very hard to make good decisions about treatment (like to get some!) when your very mind is working against you; doing it alone is terrifying and for many people virtually impossible. I am incredibly fortunate to have the support, experience, and resources that I do, and it is still a very difficult thing for me to work through. Even as I write this, part of me worries how it will reflect on Mozilla. I just wouldn’t worry about that at all if I had a “physical” ailment.

I’ll likely post more on my blog about this, but not likely syndicate to planet; it’s not really Mozilla-related, other than the fact that Mozilla, like most communities, is probably more affected by mental illness than we realize.