Self-Portrait with an invisible tattoo: How I lived with bipolar disorder for most of my life without realising it

 DISCLAIMER: The following events refer to no one person or persons in particular.  

When I was eleven or twelve, I learned about van Gogh’s death.  A teacher at school showed us the artist’s Self-Portrait with Bandaged Ear (1889) (left), and explained that van Gogh had cut off his ear before shooting himself.  The teacher also told us that van Gogh had something called manic depression. 

There seems to be little doubt that van Gogh suffered from the condition that is now called bipolar disorder, although whether that alone is what led to his death remains uncertain.  According to a recent study, which attempts ‘to assess all mental symptoms ever reported by Van Gogh in his letters or as found in other sources,’ the artist suffered from comorbid illnesses, which ‘probably’ included bipolar mood disorder (with worsening depressive episodes throughout his life), alcohol misuse, and malnutrition.  Epilepsy, too, is mentioned in the paper, while speculation persists generally that van Gogh may have had syphilis, in addition to experiencing the effects of poisoning, which was caused by licking paint brushes that were coated in paint that contained lead.

Whatever it was that brought about the painter’s premature demise—it would be unwise to assign a single cause and I certainly won’t be offering a diagnosis—my lesson at school was the first time I’d heard about manic depression.  Yet I had a strong feeling, even then, that it would play a part in my life.  I never told anyone: not only would it not have been taken seriously (to be fair, I didn’t take it seriously myself), but I also had the impression that only famous or exceptional people had manic depression, so grand did it sound to me.  In addition, despite bipolar disorder affecting women and men more or less equally, it seemed to me that it was mainly men who had it.  I don’t know where I got this idea from, but reading Touched with Fire in my mid-twenties did nothing to dispel this impression. Somewhat dated now, if anything this book only sustained the myth: among the dozens of luminaries it examines who suffered from ‘melancholy, madness and the creative impulse’, men vastly outnumber the small handful of women.  These include Emily Dickinson, Virginia Woolf, Anne Sexton and Sylvia Plath (who likely had PMDD), women who I had no chance of identifying with. 

While I struggle with the notion of ‘artistic temperament’—just as hard work isn’t sexy, nor is mental illness romantic—the idea of depressive illness giving rise to powerful artistic endeavour endures; it makes a good story.  Certainly, van Gogh worked hard, as his dazzling oeuvre testifies; yet the extent to which his mood and personality disorders may have contributed remains moot and a fascinating field of inquiry (a cynic may suggest that it’s easier to say what ailments van Gogh didn’t apparently suffer from).  In fact, in van Gogh’s case possibly more than any other artist’s, the two have become almost inseparable from each other.  Whoever it was that posthumously promoted the idea of van Gogh as the ultimate tortured artist must have known they were on to a good thing (although I confess to being as much of a sucker for films such as Lust for Life and Loving Vincent as much as anyone.  I even decided to name my cat Vincenzo after Don McLean’s exquisite song came on the radio).  How did van Gogh manage to keep working, despite being so ill?   By its very nature, manic depression involves sustained periods of lucidity.   In addition, at the vanguard of impressionism, van Gogh’s paintings almost vibrate off their canvases: the artist’s state of mind is as discernible as any subject matter they depict.  In that respect, art may also have functioned as a kind of therapy; yet, like that of any other great artist, van Gogh’s work must surely be capable of standing on its own, detached from the turbulence of his emotional life.  It is certainly possible to appreciate the paintings without any knowledge of his mental health. 

Growing up, I retained a private fascination for manic depression.  At the time I first heard of it, I might have said I’d had a premonition, except I now realise I was already living with some sort of manic depression without knowing it.  Having started my periods after I’d just turned nine, I was familiar with the rhythms, the extreme ups and downs, of my cycle, the strength of which I knew intuitively was not normal.   Not that I had much of an idea what intuition was; for all I knew, it may as well have been a ghost.  Yet, it was all I had to go on and as such, it wasn’t enough.  Being young, I believed what people told me: that it would all settle down, that periods got easier as you got older, that they were a natural, normal part of life, not an illness.  Adverts, too, told me that periods couldn’t stop me doing anything: if I hadn’t already rollerskated down the street or leapt into the back of a convertible wearing tiny white shorts, then my period was the time to do it. 

I was surrounded by stories, powerful stories, and I believed them.   Such stories were told because they were what other people believed; their stories came from their experience.  I, too, was telling myself stories without knowing it.  Yet these stories were also unhelpful, because I didn’t know the truth and, in that respect, the stories were not mine to tell. Despite my fascination for it, manic depression—bipolar disorder—remained abstract and remote, as if waiting for me in the future.  This disconnection from the condition that was so obviously a part of me remained because I wasn’t a brilliant and famous man. Failure was a feature from early on in my life—I’d already failed the Eleven Plus and was bullied heavily for starting puberty early, which apparently made me ugly and fat.  It was never the done thing to be a big head or get ideas above my station so, having internalised messages that were both subliminal and explicit, I believed the worst about myself.  As far as I was concerned, I was ugly, fat, lazy and thick, and so I blundered on with life, with bundles of sanitary towels and heavy clots between my legs, blood stains that would appear in random places, debilitating tiredness, a constant feeling of being ‘ill’, overwhelming emotions, mood swings, anger.  And shame. 

Ah yes, the shame; let’s talk about shame.  The ceaselessness of it.  Having started menstruating at such an early age—being the only one in my primary school at that time—the shame I felt was as crippling as the symptoms.  There were no books, resources or campaigns, as there are now, no free sanitary products, and I was so ashamed of what was happening to me that I tried to ignore it.  I felt like a freak; stress assaulted me from every angle, inside and out, and I tried to repress it all.  I just didn’t want anyone to know that I was having periods, even though it was obvious that I was.  If anyone mentioned periods I wanted to die and I hated my body (I could write whole blog posts on the indignity and embarrassment of PE lessons and having to wear a bra as a child—just as I wrote a blog post on the time when my period decided to tell everyone that it had arrived while I was doing my cycling proficiency test).  It was a constant battle and my way of coping was to concentrate obsessively on schoolwork.  Despite failing the Eleven Plus (to pass would have put me above my station, I suspect) I was still keen to do well academically, to prove, perhaps, that I wasn’t thick.  Plus, the teachers at my secondary modern school were brilliant (I appreciated that even then, as well as now, as I look back).  Channelling my manic episodes into my studies, however, didn’t make me popular.  When we moved from Lincolnshire to Cornwall when I was fourteen, the two years I spent at a comprehensive school there doing my GCSEs were miserable, and I found the majority of my schoolmates to be unpleasant (they probably thought the same about me).  Having experienced academic rejection—the Eleven Plus does define you, no matter what else you go on to achieve in life—I now experienced social rejection, but I pushed through the daily anxiety and fear, only to keep experiencing more anxiety and fear.  And if things weren’t working out, it must have been my fault, so I tried harder, constantly on the defensive, second-guessing everyone’s motivations.  My internal chaos normalised, peace was an abstract concept that I never thought I’d experience. Stress and anxiety were the water I swam in.  I presumed it was the same for everyone. 

Who knows what all this was doing to my long-term wellbeing.  Deep inside, my cells were being imprinted with conscious and unconscious reactions to painful experiences, the memories of which reverberate to this day.  Thankfully, sixth-form college was more enjoyable and offered some respite; I was able to be myself, had found a group of friends, and I loved my teachers.  I continued to push myself academically, too, which no one seemed to mind, although I was still not to experience peace of mind.  Meaning well but without offering any practical support in the endeavour, my college encouraged me to get ideas above my station and apply to study at Cambridge University—a naïve fantasy that involved my attendance at three separate interviews with magisterial old white men.   I have repressed most of the details of this memory; suffice it to say that, in my case, hard work was not enough for me to win a place at this prestigious seat of learning.  Whatever it was they were looking for, I appeared not to have it.  Being rejected from that place, though, didn’t really come as a surprise; rejection was the story of my life at the time and, in any case, I very much doubt that I’d have fitted in—in fact, it may well have been a disaster for me and screwed me up even more.  So my not getting in was probably a lucky escape. 

Most of the other universities I applied to appeared to think the same as Cambridge: I was rejected by all of them except the University of Sheffield and, to this day, I remain grateful to it for being the only university to show any faith in me.  For that reason it felt, even then, as though we were destined for each other: the city fitted me like a glove and it was as if those hills were giving me a big hug (I feel so lucky to have lived there and happily—rapturously—still would).  It wasn’t all failure, either: not to be a big head about it but I’d done well in my A-Levels (more than well enough to go to Cambridge, in fact).  Any confidence I may have had in myself, though, had vanished, and I’d had enough of academia before I’d even started my degree in English Literature.  I’d had enough of most things—hard work and toeing the line only seemed to make me miserable.  So rather than throwing myself into my studies, I decided to reinvent myself and gave myself up to a social life the like of which I had never had before (or since), becoming a sort of cross between Moll Flanders, Fleabag, and Fraulein Sally Bowles—a wannabe Courtney Love, only with alcohol instead of drugs.  

I didn’t understand it at the time but this was a psychological defence against what had happened in the past, and which in some ways continued to happen.  Having constantly been called ‘‘angin’ at school in Cornwall (a word I’d never heard before moving there), I was also now being called ‘slapper’, which was another word that was new to me, so naïve and impressionable was I.  Still so very young—a laughable eighteen or nineteen—I was now hearing it constantly, and always from boys (I would hardly have called them ‘men’).  The strange thing was, though, that I didn’t mind.  I needed to find validation from somewhere and, sadly, thought that the male gaze might help me feel better.  For a while, it did (I was no longer being called ‘’angin’’, which was progress for me).  In addition, while some of the boys I messed around with were sleazebags, others were lovely, and I thought I was getting something out of my system.  For the first year especially, I was in a more or less constant mania and university was a bubble that insulated against the real world, helping to sustain the fever.  In his documentary, The Secret Life of the Manic Depressive, Stephen Fry mentions the cliché of taking your clothes off and dancing on tables and, at university, I did plenty of both.  There were slumps too, when I would sleep heavily, at all hours of the day, possibly partly because I was anaemic.  In my first year at Sheffield, like every student I saw the film Betty Blue and empathised with the title character, although I didn't know that she was bipolar.  Just as van Gogh cut off his ear, Betty Blue pulls out one of her eyes, which I could now say refers to a kind of blindness I had back then: I just couldn’t see what was in front of me.   Or I wasn’t trusting what my non-visual sixth sense—my intuition—was trying to tell me. 

What is obvious to me now, and which was slapping me around the face then, remained elusive throughout my twenties, thirties and half of my forties.  I was and am ill: the bipolar extremes were and are very much there, but back then I didn’t know that that was what they were.  Just as I wrote the assignments for my degree, so was stress inscribing itself deep into my body, indelibly, like an invisible tattoo.  God knows how I managed to get that degree, but somehow I did and, still only 21, I then had the bright idea to enter teacher training (not in Sheffield) and get a Post Graduate Certificate in Education (PGCE).  I ought not to have been there but, despite my antipathy to my degree studies, I was in love with my subject, had been inspired by my own teachers, and thought I might have something to offer the profession.  Any sentimental Dead Poets Society bullshit inspiration I may have had, however, soon evaporated at the cold classroom coalface.  Television advertising campaigns today speak of support, generous starting salaries and career prospects, all to the sound of a romantic piano soundtrack.  But this is a representation of the teaching profession that I never recognised in my early days.  To begin with, the school environment was an unhealthy one for me. Well-meaning but ineffectual university tutors were good on pedagogic theory but had no clue about the reality of managing difficult classes—the holy grail to us student teachers—while the attitude of the jaded professionals I worked with at my placement schools could be summed up with the remark one of them made to me early on: “If you think it’s hard after one lesson, wait until you have to do it all day.”  They were up against it and could have done without us students. 

It was only a year but it may as well have been ten and, when I wasn’t at work, ‘home’ was a musty flat with no shower and no central heating.  God, that PGCE year was grim.  I knew at the time that it wasn’t setting me up for the profession but I was stubborn and wanted the qualification—to be a qualified teacher, even if I didn’t feel like one.  When I eventually did qualify, I amazed myself as much as anyone else, particularly the teachers at my placement school, who I was sure had written me off as a hopeless cause. They weren’t that far off, either, as I was too scared to apply for any jobs.  Still only 23, I fell into my first permanent post, teaching English at a secondary school, via a series of supply gigs (an even more degrading experience than the training I’d just been through).  This school included a grammar school stream (as did other schools I taught at subsequently), which was an eye-opener and made me realise that I hadn't missed out by failing the Eleven Plus, after all.  I didn’t look like any of the other teachers, or feel like how I imagined a teacher should feel but, being young (and therefore cheap—hence why the school kept me on) I had a certain stamina that was also borne of naïveté.  My work ethic was strong and I somehow managed to teach through depressive episodes, so that I hardly took any time off, which seemed to me to be more trouble than it was worth (hence too the time when I participated in a five-day school trip to the Netherlands, during which I now know to be a full-on depressive episode).  I just thought I was tired, bloody tired—cripplingly, devastatingly—at the end of each day, causing me to wonder why no one else ever seemed to get as tired as I did.  There were times when mania would show up in classrooms, too, which also didn’t seem unusual to me; I just thought that I was having a good day. Those manic episodes helped me do my job—when I would feel unstoppable and capable of anything—but when things were hard, I blamed myself.  Overall, my confidence remained low—I never felt secure in the teaching profession, or owned myself in it.  As if I was a satellite dish attuned to it, toxic energy soldered itself into my cells, and I continued to troll myself, abusing myself with the kind of self talk that would get me locked up if I spoke like that to anyone else.  I was never good enough; everything was my fault.  I was a cunt.  As Stephen Fry says in his documentary: “To stand up from the sofa and walk to the fridge is an unbelievable effort.  Everything that happens is because you’re a cunt.  It’s because I’m a complete wanker, an arsehole…” 

It was while I was working at my first school that I met the man who is now my husband. Looking back, it feels as though I was being led to him (albeit via a rocky path), as he was the first man I had ever met who didn’t make me feel fear on some level, or like prey (he had also been to Sheffield University, albeit nine years before I had).  Not that this put an end to any of the trauma I was experiencing, or reliving back then.  My body constantly wound tightly with terror, I was stalked by fear and trauma everywhere I went, still repeating the same old embarrassing patterns, like a weird young female Alan Partridge, only worse.  And I carried on living and teaching this way, at a variety of schools, until my late thirties, when I was just starting to reconcile myself with the profession I had struggled with so much, and feel proud of my record.  My depressive episodes had become so bad, though, that I could ignore them no longer.  I had no choice but to pay attention; each depressive event occurred with a violence of which I lived in constant dread (In Loving Vincent, van Gogh’s friend Dr Gachet explains that those with ‘melancholia’ can change from elation and euphoria to suicidal in six hours; in my case, it can happen within minutes).  It had taken me this long, and I had to get to this point, to realise what was happening to me; that what had become my natural state of normalised trauma was not normal.  And I still didn’t know what any alternative could be, or how to access it. 

An epiphany occurred in 2016, when I was 42, thanks to Germaine Greer—Germaine Greer! The most fearless person I can think of—who visited my town to give a talk at the theatre. Love her or loathe her (and she doesn’t care either way), she is a living legend with some incredible tales to tell, an icon my town never normally gets to see.  The auditorium was packed with people keen to hear her speak and, when she asked afterwards if there were any questions, I raised my hand.  I knew beforehand that I wanted to do this, and was still shaking as I grasped the microphone, despite having drunk a bottle of red wine in preparation.  My voice shook too; I was as nervous as hell (when was I ever not?)  But I wanted to know: did she ever get nervous? 

It was probably not the sort of question she was expecting.  The contempt and disdain in her voice was obvious; we all know this woman doesn’t suffer fools (and I sure as hell felt like one).  And she took a while to get round to a straightforward yes or no, digressing into feeling nervous for the planet, ecological terrorism, mass extinction, the frustration she felt on travelling to our town and seeing the apparent obsession with tidy lawns and manicured roundabouts that should be left wild…  But then it came: the ‘no’, that had never been possible for me: she personally never gets nervous; she simply doesn’t do ‘nerves’.  ‘Nervous’ was never an issue for Germaine Greer. 

Of course!  Of course Germaine Greer doesn’t do nervous.   On some level, this was something I must have already known.  But the idea that there are people who never get nervous, or suffer from anxiety, who are able to go about life with ease and at peace—that this was possible—seemed fantastical to me; something I had never consciously considered. But it’s true: there are people who do not live in a constant state of fear, shaking everywhere they go.  There are people who do not live as I did, paralysed by emotions that dominate and overwhelm.  Yet I needed to have it brought into the daylight for me, to have the idea brought up into my conscious awareness.  No wonder I was a mess, and that my body had broken down.

Ever since I was nine, when my first period came, my menstrual cycle has towered over my life like a colossus, or a giant red wall, unscalable, impenetrable.  The blood that appeared was always profuse, thick, hot and clotted, more like lava than blood.  And it wasn’t just the blood that was heavy; my emotions, too, were laden with heavy metal.  And so I clanged about, oblivious to the mental illness I was enduring, which was central to my life without me seeing it.  To experience something so obvious and for so long, yet without knowing: I now see that I was living a kind of madness.  Yet, pre-menstrual dysphoric disorder (PMDD) was my natural state.  When I was finally diagnosed at 44, the relief was immense. Finally, I had a story to tell that made sense to me.  A close relative of bipolar disorder, PMDD is caused by the brain’s response to hormonal fluctuations—the menstrual cycle—and therefore cycles more rapidly, on a monthly basis (BipolarUK acknowledges the role that hormones play in bipolar disorder).  What causes this to happen in some women and not others is not clear; as with bipolar, the causes of PMDD are not understood.  Genetic and environmental factors, as well as stress and trauma, have been mooted as playing their part in causing both conditions.  In any case, the lived experience of both is identical: both involve episodes of debilitating depression and elevated mood (‘mania’, or ‘euphoria’) and, in effect, PMDD may be thought of as hormonally-induced, rapid-cycling bipolar disorder.  If I add up my monthly depressive episodes over a year, the total would amount to full-blown type 1 bipolar disorder, and I often wonder whether I would prefer to experience my episodes all at once, and get them all over with.  I cannot imagine the dread and fear I would feel, knowing a three-month long depressive episode to be imminent. As they are, my worst symptoms may not last as long—up to a week a month—but the repetition, the grinding relentlessness of the constant swings between extreme states, and the aftershocks, leave me exhausted.

Knowing what I know now, if I could go back to my younger self, what might I say?  I may tell myself to trust myself more, to believe my instincts, and to give a voice to them, to try and describe what was happening in my body to myself and to others.  Because I have a right to my story, to show up and tell it, to own and speak my truth.  Up until very recently I didn’t feel I had a right to tell my story, but now I realise that I do have a right because, like a form of therapy, telling my story, painting my self-portrait, helps me, and so it may help others, which is what stories are supposed to do.  Stories are integral to the human condition, yet they must be the right stories, because the stories I’ve told myself until recently haven’t served me.  For example, I always wanted to write but, despite having studied and taught English Literature and creative writing for much of my life, I made myself small and believed the wrong story, that I wasn’t worthy to be in any space (I embraced with a vengeance Malcolm Bradbury's advice that writers must accept rejection and reject acceptance, rejecting myself before anyone else would ever get the chance to).  Thankfully, after my PMDD diagnosis and with the luxury of getting older, this is all starting to fall away and, as if squeezing a tube of toothpaste, my story is oozing out slowly.  If I’d known before what I know now, I might have realised that the psychosis of my life—most of what I saw and heard and thought and felt—was an illusion.  I might have lived my life differently.  Yet, here I am now, having learnt that telling the right stories is so important, that it can be almost as healing as any other form of medication, if not more so. This has certainly been the case for me. 

On a macro level, too, it’s clear that telling the right stories about women’s health is crucial. While awareness of pre-menstrual dysphoric disorder is vague, it is growing, thanks in part to vociferous campaigning by organisations, such as The International Association For Premenstrual Disorders (IAPMD) and Vicious Cycle PMDD, as well as individuals.  In 2019, too, the World Health Organization (WHO) added PMDD to the International Statistical Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11), which helped increase the credibility of the disorder.  However, PMDD has a long way to go before it is as established within the public consciousness and taken as seriously as bipolar disorder.  This is for a couple of reasons.  Not only does bipolar disorder have the advantage of an illustrious and romantic history, but it is also a condition that affects men as well as women, a fact that inevitably influences how it is perceived.   For example, when a famous man has bipolar disorder, he’s more likely to be viewed as a genius, a visionary.  Even if he has not officially been diagnosed, if a male genius is perceived to be strange, unpredictable or difficult, it is often assumed that he must have manic depression (turns out that van Gogh is not the only artist to have had his medical history examined and his genius explained by bipolar disorder.  Beethoven too, has been subject to these speculations).  Yet, when it comes to women, society rarely makes the same connections.  If a woman is bipolar or has PMDD, we are not thought of as brooding geniuses; bipolar is not a superpower that enhances our abilities.   Instead, we are perceived as unpleasant and unstable—hysterical, even—our physical symptoms apparently able to be ‘cured’ with antidepressants, food supplements (usually vitamin D or magnesium), and electric fans.  If only it were that easy. 

Gustave Courbet (1819-1877)
Self-portrait, Man with a pipe (left), 1848–49, Musée Fabre, Montpellier
Self-portrait (The Desperate Man), c. 1843–45, Private collection

While meditation, eating for the gut, and forest bathing are no regrets activities that anyone can do to enhance wellbeing, none of it seems to make any specific difference to my PMDD.  Only two things have done that: time and storytelling.   Washing my hair, doing laundry, cooking a simple meal, making lists—these are all signs that my depressive episodes are easing.  The stories I tell myself about bipolar and PMDD also have a positive impact on my ability to live with these conditions, helping me unlearn the bullshit I’ve internalised over the years, and reject the things that do not serve me.  It is why I’ve lately started to define my illness as ‘PMDD with bipolar rising’.  Do I imagine myself as a great writer, moodily brooding in a Paris garret, perhaps, or staring out of a gilt-framed painting in a famous museum (like Courbet above)?  No, but in the western world at least, such is the archetype of the bipolar genius, who is usually white and male, an intense figure engaged in an act of creation that will be considered a gift to humanity.  Hard work is rarely mentioned, nor the infrastructure and support (otherwise known as a wife) that enables the genius to focus exclusively on his endeavours.  'Genius' is reserved for the most powerful in society; it’s one of the reasons why I struggle with the concept.  And it certainly does not reflect the reality of living with bipolar disorder when, on some days, merely standing long enough to take a shower is a win.  Any achievement, genius or otherwise, occurs despite the condition, not because of it. 

Storytelling is a sacred, though often abused activity, which is why it’s important to know who is doing the telling, why, and for whose benefit.  My PMDD started with my periods, so will it stop with my periods, too?  Will the menopause put an end to all this?   I await the outcome of this instalment, which is writing itself at this very moment, with interest.  There are those who insist that mental illness doesn’t exist, that it’s the soil, not the plant that is at fault; the system, not the person.  Or worse: 'What you believe, you receive' (in that case, I believe I'm going to win the lottery).  These ways of thinking—these stories—do not acknowledge that illnesses such as PMDD and bipolar disorder are real, and are used to gaslight those who do have these illnesses.  As I sit typing this in January 2021, I am aware that I too am guilty of downplaying my symptoms.  At this time, my senses are cleaner and sharper; I am lucid and on top of things.  But only a couple of weeks ago, on Christmas Day, I was a different person, catatonic, unable to move or speak, and incapable of Zooming my family.   As I look back on that time only a fortnight ago, I am unrecognisable even to myself.   Yet, I also know that it won't be long before I will be that person again.  I suspect that even if I lived in a Utopian fantasy, in a house in the middle of a forest, my symptoms will continue to feel real and true to me.  I must carry on telling the right stories.