Benjamin Howarth on bipolar disorder

This article was originally published as part of 2014's Geek Mental Help Week, and includes an update from Howarth in 2015.

Two sentences have changed my life.

• "Do you think you might have depression?"
• "I think you might have Asperger syndrome."

The first was in June 2013. After four months of difficult personal issues (involving way too many hospital visits and an operation on my throat), I was sleeping too much, and struggling to find any energy to get out of bed in the mornings. Not like 'I've had a late night' tired. More like 'I'm half-drunk, been hit by a truck, and three coffees won't wake me up' tired.

My ex-girlfriend had a blood test which showed up positive for glandular fever, which I thought might explain my chronic tiredness, but mine came back negative. It was at that point she suggested I had depression. So I called my mum, and I broke down into tears.

The next day I went straight into my doctor's office and collected a fluoxetine (aka Prozac) prescription. Within a couple of weeks, whilst my mood didn't 'lift', I was able to sleep better – back to a regular six to seven hours a night, which meant I had the energy to be able to think straight again, and was therefore able to do my job a little better.

Early signs

The second was when I was 18. My mum had been doing some online research, as I'd been a 'smart, but must apply himself' teenager. I flew through exams that I found easy, such as mathematics, music, sciences and the like, but failed essay-based subjects like English and literature.

Teachers in the subjects I aced despised me (one told me she "never wanted to see me again") for having seemingly done no work and still walking away with an A grade.

Asperger's seemed to fit the bill – socially outgoing but awkward, took things too literally, mood swings and OCD, but brilliant at science-based subjects.

Antiquated approach

My GP had no idea what Asperger's was, but I went back two weeks later to find out what could be "done" to help me out, and I received a referral to my local mental health trust for an assessment.

After sitting in a very long room (imagine the Hollywood-style scenes you see of shelves with books, worn desks and nice Regency furniture, with two bespectacled people with clipboards sat opposite me, a young hot-headed teenager) for about 20 minutes I was told they felt I had some symptoms, but not enough to warrant formal diagnosis.

Whilst I'm extremely proud of Britain's history involving the NHS, mental health is very antiquated here and in other countries, and is highly stigmatised even today. I felt my diagnosis was a 'cop-out' to avoid having to pick up the pieces of 15 years of educational support I may have been able to receive – but I digress.

Bipolar diagnosis

Over the course of the past six months, I've had a proper diagnosis of bipolar disorder and my newly-assigned psychiatrist has acknowledged that I have elements of Asperger syndrome, that are useful to consider when discussing treatment plans.

Bipolar is a challenging thing to live with and manage. It's also known as 'manic depressive' disorder, which infers that someone is maniacally depressed. This isn't true.

'Manic depressive' accurately describes the two opposing and separate states my mind can be in at any time.

Manic euphoria

'Mania' is a fantastic part of my life and my existence. It's a euphoria that illegal substances probably couldn't supply you with. Not that I've tried – I've always realised that whilst my peers may find their kicks at the end of a white line of something, my mind is a delicate thing that doesn't need anything more affecting its regular operations.

Between January and March this year, I was single and dating, writing some of the best code of my life, speaking on podcasts, at technical conferences, and sleeping four to five hours a night. I was the life and soul of the party, and whilst on holiday in Prague in March for my birthday, I went to bed at 1am, woke up at 4.30am, realised I wasn't going back to sleep, so went to the gym, ran 5k on the treadmill, and spent another hour-and-a-half doing weights.

For me, mania is fantastic, providing you can channel the extra energy your mind 'magically' has, to capitalise on it and focus that energy into your work.

Depression

Now for the coin-flip.

Depression doesn't just 'happen' (unless you have what's called rapid-cycling bipolar, which is when your mood flips from one extreme to the other more rapidly than normal). In most people, it creeps up on you, brought on by small but significant triggers.

For me, monotony in my work brings it on (one of the reasons I suit freelancing better than being employed). Personal issues in my private and family life may contribute (as they did in 2013, and have done so recently – as I write this, I'm in a very low depressive mood, one of my lowest to date).

When you're depressed, everything is a struggle. From getting out of bed to thinking about the current code you're working on, every single thought is a titanic effort, like climbing Everest without an oxygen mask.

How it feels

It's like your mind has gone from being hyper-electrified to being weighed down with tar or treacle. You know you have to keep moving to escape it, but it bogs you down more and more, until you can't actually get out of bed in the morning.

In my low moods, without medication, it takes me two hours to summon the energy to get out of bed. My brain doesn't hear my alarms in the morning, even if I set six of them, ten minutes apart, over the course of a whole hour.

You don't want to leave the house because you're content; safe in your own private cocoon. You stop caring about your personal hygiene (I sometimes only brush my teeth once every couple of days) or your appearance (I stop thinking about shaving so regularly).

Coping strategies

Cognitive behavourial therapy has tried to help me with 'life strategies' – ways to live my life on a daily basis that align with my personal values.

Depression doesn't alter how I feel about the people around me, or the values that I try to live by – delivering great work – it just makes the negative stuff more pronounced. You feel guiltier for missing a deadline, or not going out for drinks with colleagues, or for missing a simple bug in your code, and the guilt compounds how you already feel.

CBT tried to introduce me to meditation, and whilst I don't follow guided meditation, I do have a mental place that I try and go to 'escape'. In my head, it's a Japanese garden, with jasmine blossom and a waterfall and a nice pagoda where I can sit and enjoy the tranquillity. When I'm depressed, this garden turns to autumn, or winter. Recently since it's been really bad, the garden has been burning to the ground.

Hopefully I'll find a way to rebuild my garden so it's more beautiful than I last remember it.

Update for October 2015:

After writing the above post last year, I entered a long period of stability, notched up some great work, ran the London Marathon, got my hands dirty in the General Election, and afterwards needed a very long break.

I took a long holiday touring Europe, but I felt something was amiss – after the hectic schedule of March and April, the lull in May was making my mind wander in ways I didn’t like.

In August I entered another slump, and after a month realised it, so went to my psychiatrist, who increased my fluoxetine dose from 20mg to 40mg. Things are now getting stable again, which is just in time for Christmas.

I’m starting to recognise that with my medication, my bipolar swings are starting to become less severe, and more predictable, arriving around the same time each year, in August or September (although I only have this year and last to actually measure that against, however I’m hoping it’s a trend that I can subsequently anticipate and manage better in the future).

I’m still waiting on a re-referral back to cognitive behavioural therapy, which I think I still need. Having waited this long, I am tempted to go private, but it’s not cheap, with sessions starting at £80/$120-ish each (and that’s at the 'cheap' end).

However, the awareness of my illness has helped me enormously when liaising with clients, as they understand that some days are good, and some days are absolutely awful, and have been amazingly flexible and accommodating accordingly.

Thankfully as a freelancer, I am measured on the quality of my work, not whether my bum is in a seat at a particular time of day. Finally, if anyone wants to share their experiences with me, or ask any questions, they can find me on Twitter @benjaminhowarth. Now, it’s almost Halloween, where’s my straightjacket for my costume…?

Also read...

• Chris Murphy on web design and mental health
• Ed Finkler on anxiety and attention disorders