Episode 7: Living With Bipolar
Ana Agarrat fills up the room. She’s bubbly & gregarious—the type of person that, upon meeting her, you assume she’s one of those people who has it all together. Yet, perceptions are misleading. Discover the upending world of Bipolar and learn how Ana has found a new sense of equilibrium and purpose in her life through a strong support system, letting go of perfection, and cultivating valuable skills to navigate uncertainty.
Ana Agarrat: [00:00:00] I'm Ana Agarrat. I'm here in Chicago with my husband, Elliot, and our dog, Prince. I'm from Trinidad in the West Indies in the Caribbean.
Ellie Pike: Ana Agarrat fills up the room. She's bubbly and gregarious, the type of person that upon meeting her, you assume things like, "She must have a lot of friends. She's got it all together." Does Prince want to say hi?
Ana: Prince, can you bark on command? Speak, speak, [00:00:30] come on.
Ellie: I have to take a picture. She's so warm, open, and friendly that you wouldn't have the slightest clue that she's living with bipolar II disorder, and that it nearly wrecked her life. Elliot, how would you describe Ana?
Elliot: Strong, a very strong person even when she feels weak. It takes a lot to go through what she's gone through and come out successful on the other end. I feel like she's successful.
Ellie: That's the beauty of Ana. She's [00:01:00] found that there is great strength in vulnerability. In this episode, we'll walk with her as she shares about the journey that taught her the power of a strong support system, how we can let go of perfectionism, and that even though life is not easy, getting the right mental and emotional tools that empowers us to navigate pitfalls. Our story begins in Trinidad in the middle of a military coup. You're listening to Mental Note. I'm Ellie Pike.
Ana: When I was around five years old in Trinidad where I grew up, we had almost a civil uprising. My mommy rounded us up and we walked the long way all the way around the park back to our house. There were people with these huge, huge guns, these long guns standing on the corner because we lived directly opposite a police [00:02:00] station. We didn't realize at the time that they had taken over the police station and had commandeered it.
Ellie: Was your mom watching, and she was trying to protect you guys?
Ana: Yes. We were all gathered in the central room in my house which was the safest one. My parents had pulled all of our mattresses out of our rooms, and so we were sleeping on the floor. My mommy would crawl on her hands and knees to go to the kitchen to get breakfast and lunch and dinner for us and crawl it back to us because [00:02:30] we were staying low. Now, when I reflect on it, I know that even though I may have disregarded it in the past as just like a small trauma or something that's just from memory, something that doesn't really have that much of an impact, I realize now that maybe that does have an effect on the way that I think about any situation, feeling like, at any point, things can slip into chaos.
Ellie: Wow, that's a really [00:03:00] big lesson in life to learn at the age of what, you said four?
Ana: As a nation, as a country, our people, we are very lackadaisical. We approach things in such a laidback fashion. After all of that happened, the country went back to business as
normal. It was almost as though all of that was washed under the rug even though people had lost their lives, that [00:03:30] there was a huge bombing in one of our central government buildings, everything is fine, and I felt like I couldn't readjust. [chuckles]
Ellie: Right. You couldn't fully settle into, "We're fine. We can now just chill." These lessons learned during Trinidad civil unrest combined with Ana's vigilant personality type to make her a more anxious person, a trait that didn't fit well in her family.
Ana: I always had these mood swings and was always very sensitive. My arms were crossed. [00:04:00] My face was probably a little bit sullen.
Ellie: How old do you think you were?
Ana: I was probably like 9 or 10. My grandfather saw me. He was just like, "Don't cross your arms." I was like, "What?" He's like, "Don't cross your arms. That's so unapproachable. That's not the way you want to present yourself to people." It was from very young the idea that I should be open, I should be inviting, I should be bubbly, [00:04:30] smiley because the other parts of my emotions, my other moods, those weren't acceptable. Those weren't the ones that anyone wanted to be around.
Ana: I'm not certain why, but I remember being 10 or 11 years old and wanting to end my life. Even before then, I remember feeling like I just wasn't enough [00:05:00] and that my family would be better off without me. It's difficult for me to understand why I ever felt that way in the first place. It makes no sense. From my perspective, I didn't go through some horrendous trauma that I could pinpoint to be, "Okay. That was what changed it." You know what I mean? That is why I no longer wanted to live. [00:05:30] For me, it just felt so insidious and innate that suicide was always the option.
Ellie: Did you know that that wasn't "normal"?
Ellie: You assumed other people have these feelings, too?
Ana: I've always had such an intense internal monologue that I assume that everybody else did as well. I wasn't certain if everyone was contemplating thoughts of suicide, but I knew that [00:06:00] people did commit suicide. I didn't know who they were personally, but I knew that it was a thing.
Ellie: Moving on into your teenage years, what happened with your mood swings?
Ana: The mood swings continued to go up and down, but I think in a tempered way. When I really started to have much deeper ones, I would say, was when I was 18 and I moved out of my home. I was in school in Jamaica, so I was by myself for the first time. That was [00:06:30] when I think I really started to see the depths of where the darkness went. I felt so disconnected. I wasn't even really 100% certain that I was physically present there. It's very difficult to describe.
Ellie: Right. In psychology terms, we would probably call it dissociating, [00:07:00] right? Without knowing the terms you just felt like you were out of your body maybe?
Ana: I felt like I was out of my body. I'm so into sci-fi. I'm really all about parallel universes and wormholes and stuff like that. For me, it almost felt like I was existing in
two realms at once.
Ellie: Interesting. Then what would bring you back and ground you back into your present moment? It didn't really happen. You're shaking your head at me.
Ana: It didn't really happen because, [00:07:30] at that time, my coping skills were drinking and going out and avoiding the important-- When I say the important things, I mean avoiding real connections. For example, avoiding real connections with my family or real connections with my friends. It was so many superficial relationships and a lot of avoidance behavior that I know now.
Ellie: What were you avoiding?
Ana: I felt like a fraud. [00:08:00] I felt as though I was living this life that was completely made up and it was not who I was at all.
Ellie: That was when you were in school in Jamaica. Moving through that time period, you were feeling so disconnected from yourself and also other people, but yet working really hard in school, right? [00:08:30]
Ellie: Where were you in life? What was your track that you were moving towards?
Ana: I was moving towards becoming a doctor. In Jamaica, I realized that was not going to happen. I was so depressed and that was not working for school. I was not achieving the grades that I needed to, to continue succeeding. I moved back home to Trinidad, and I worked and applied for school, and then eventually came to undergraduate here in the United States pursuing pre-med again, biology, and [00:09:00] all the sciences.
Ellie: Ana worked herself to the bone pursuing the goal of becoming a doctor. She was sleeping an average of four hours a night in order to fit in all her commitments and schoolwork.
Ana: Resident assistant, student ambassador, everything. I did every extracurricular activity I could. I really thought that's what everyone did. I was like, "How is it that everyone can do all these extracurricular activities and still be 4.0?" Obviously, no one is sleeping just like me. I started seeing a therapist but honestly, [00:09:30] I didn't have the time. I didn't have the time to do the work that was necessary. I didn't have the time to sit down for an hour every week. I was high for a really long time. When I was low, I think that I was so busy, and there was so much to get done that I did not see it as a low. I thought I was tired.
Ellie: At what point did you seek help to the point where you got a better diagnosis of what was really happening?
Ana: That didn't happen [00:10:00] until graduate school.
Ana: I came to Chicago for medical school, it was my pie-in-the-sky school, I never thought that I would be able to get in there. I've been reflecting on this so much more now and I feel so much more convinced that I never ever really was convinced that I would be [00:10:30] a doctor. Regardless of how much external validation I got, regardless of how many people told me I would do great in that profession, and regardless of any successes that I may have had on that path, I never thought that I could do it. That was so much a part of my impostor syndrome, I never felt as though I belonged in medical school.
It's not because [00:11:00] the people weren't great, my deans were amazing, my classmates were amazing, they're still some of my best friends, but I just didn't see myself with them, I saw them as so much better. My dean in medical school was the one who suggested I see a psychiatrist. At first, of course, I was very hesitant, I went anyway because I knew that I needed help. I could not get up out of bed, it was a struggle to get to class, [00:11:30] things were going downhill. I saw my psychiatrist for the first time and I feel like she immediately knew what was wrong with me.
Ellie: All of this was happening while you were talking with your psychiatrist and she gave you a name, your diagnosis that is. What what was it?
Ana: Bipolar disorder type ll.
Ellie: You might be wondering what bipolar is. Here's Ana. [00:12:00] Can you describe that for me, what is it?
Ana: Bipolar disorder, as I mentioned before, commonly known as manic depressive disorder, you can imagine your emotions and your moods on a spectrum. At one end, euphoria and everything that feels lovely, and at the other end, just the deepest, darkest blackness that you can ever imagine where with bipolar type l you go all the way from one end of the spectrum [00:12:30] to the other. With bipolar disorder type ll, the span isn't as large and the cycling can also be different.
Ellie: Irritability goes with also increased energy, lack of sleep but sometimes impulsive decisions, right?
Ana: Yes. A lot of times impulsive decisions can mean shopping, can also mean promiscuous sex, all these different impulsive decisions that can be made without you really knowing, you're just acting [00:13:00] on urges.
Ellie: Sure. Then you were also experiencing that depressive side of things in your 20s, do you want to share about that?
Ana: During my first year of medical school near the end of my first year is when I met Elliot and I told him about my diagnosis and everything, and about medical school and how I felt like I wasn't going to make it. He was so supportive, it was so awesome and he stayed with me. [laughs] It was great. [00:13:30] We moved in with each other after a year and school once again started going downhill really quickly.
Ellie: While bipolar was her disorder, the real culprit was shame at her perceived failures.
Ana: I was preparing for my step one board examination, the USMLE has different steps in your process to become accredited as a medical doctor. Once again, the imposter syndrome was flaring. [00:14:00] I knew that this standardized exam would be the proof of how little I was prepared to be a doctor. Instead of making plans to study for the exam, I made plans to end my life.
Ellie: Ana truly believed that if she couldn't be a doctor, then she couldn't be anything. This test presented a major obstacle to her goal and she'd already convinced herself of failure [00:14:30] before even trying. During the four months leading to the day that Ana had planned on taking her own life, she shut down. She stopped answering emails, stopped talking to friends, she even stopped going to class.
Ana: For four months, I didn't even really live. It was such a false existence.
Ellie: Were you going to class?
Ana: I was not going to class, I was just at home. During that time, when Elliott [00:15:00] would wake up in the morning and leave for work, I would wake up with him, I would watch him leave and then I would go back to sleep.
Ellie: You were good at pretending and I'm sure that didn't help all the feelings you already had about feeling like a fraud.
Ana: Well, I was lying to him. It wasn't pretending, I was lying.
Ellie: Right. Even more, you're like, "Actually I was a fraud [unintelligible 00:15:21]"
Ana: I was most definitely a fraud to a person who had nothing but love, care, and respect for me which made it even worse and so [00:15:30] for me, that was even more impetus to go through with the plan because what I was doing for me felt unforgivable and so if I did not go through with my plan, I had backed myself into such a corner that there was no life to live afterwards anyway.
Ellie: What changed because you're obviously here today.
Ana: I'm here. The day of, one of my dean's who had been trying to reach me got a hold of Elliott [00:16:00] via Facebook, right?
Ana: Via Facebook. Elliott called me and I was on my way out of the apartment and I knew that if I had taken the phone call that things were not going to go the way that I wanted to, but he called twice and I was like, "Okay I'm just going to take the call and alleviate any fears or worries that he may have and just make it seem like everything is okay," but then as soon as he picked up the phone [00:16:30] and he is like, "What is going on?" I cracked.
Ana: The very next day, the same dean came to see us too.
Ana: He came to our apartment.
Ellie: Wow, so then your perspective was broadened and you also had these people that really cared about you. Essentially it sounds like your dean saved [00:17:00] your life really.
Ellie: It seems like it was a wake-up call for you.
Ana: One of the mandates of me being able to continue in school was treatment, so I had to start treatment. The treatment center that was recommended by my psychiatrist was Pathlight Behavioural Center, a partner of Eating Recovery Center.
Ellie: Ana's mandated treatment brought her to the care of Dr. Andy Stone.
Dr. Andy Stone: Hi, I'm Dr. Andy [00:17:30] Stone. I'm the clinical director of the Mood and Anxiety Program at ERC Pathlight. I remember her sitting in the waiting room, with a huge, huge smile on her face. I hadn't met her yet and I was thinking to myself, "She's got a lot of work to do." I just had that feeling that she was willing to do it. We don't fix people, we help people learn how to develop [00:18:00] self-compassion, self-love in order to heal.
With an overactive mind like Ana's in the beginning, she would say she was her fiercest critic. One of her thoughts I'm sure she said was, "I am a failure because I failed at medical school."
Ellie: That even hurts to hear.
Dr. Andy: Yes. She believed that, really believed that she [00:18:30] was a failure. Our approach was rather than try to reframe that thought or change that thought with a more positive thought, we taught mindfulness skills whereas to just notice that thought, observe it, describe it as non-judgmentally as you can, and if you can do that over and over and over again, eventually that thought doesn't have that piercing, [00:19:00] it doesn't pierce you with pain as it once did and soon you'll be able to just let it go. Thank your mind for saying that and get on with your day.
Rather than the statement fake it until you make it, practice it until you believe it. I think that's why her coming to [00:19:30] our program and doing intensive treatment, she had the structure, the skills and the time to practice and practice until she really believed in it and that's really believing in herself.
Ellie: Wow. Changing and practicing behaviors but also acceptance of these thoughts until it felt authentic and real to her.
Dr. Andy: Exactly. Authenticity I think is really to me what the goal of recovery is but that [00:20:00] there's never an end to recovery. The skills that we teach, how people learn how to feel better they're not necessarily going to feel better right after they've completed our program, they're learning how to feel better. Medication can really help as an adjunct, can give your mind or brain just a little bit, take the edge off things, give it a little bit of a boost so that you can use the skills productively, [00:20:30] and efficiently, and effectively.
Ellie: New coping skills played a large role in Ana's recovery as did connection.
Ana: One of the things that I think is really amazing about DBT and also mindfulness is the idea of just so it is what it is.
Ellie: Accepting what it is, whatever is happening?
Ana: Right, without the need to modify [00:21:00] your reality. I think that a lot of my energy is always spent in my mind trying to change and trying to modify what I'm actually experiencing, without just being present and experiencing it the way that it is. I feel there is so much peace that you get. It was interesting a lot of what we talked about with emotion regulation, so emotional awareness [00:21:30] and understanding the origin of emotions and how as human beings, we used our emotions to incite and ignite connection.
Something like sadness which I always deemed as so negative and something that I wish I could just do away with at all times. I would just feel like why can't I live a life without feeling sadness, realizing that that [00:22:00] was actually an emotion that drew other people towards you. When people can see that you're sad they come towards you, and they surround you, and they fill you up. That's so important and that's a part of who we are as humans.
Ellie: Right. Everyone relates to that emotion. Even though we deem it as negative, it seems like it's actually positive and connecting.
Ana: Yes. For me, another emotion that I deem is very negative would be anger. Being able to realize [00:22:30] that that anger is actually a recognition of something that I care deeply about being threatened. That's almost like a signal to me like I care about this, this is important to me and I'm going to protect it.
Ellie: It shows you your passion. Yes, I love that.
Ana: Yes. It's been really helpful because then when I'm able to understand my emotions I can understand other people's emotions as well and I think that that helps relationships. [00:23:00] Interpersonal effectiveness which is another part of DBT I think naturally stems from that and I shed a lot of that with Elliot too so that our relationship could be stronger so that we could see each other in whether it'd just be normal emotions or in an emotional crisis and be better able to support each other. Because I didn't want this to just be a one-way thing. I feel terrible thinking that he had to support me for as long as he did. [00:23:30] I want to be able to support him too- [crosstalk] [laughs]
Ellie: Knowing those emotions goes into every relationship.
Ellie: I love that.
My main question was what's it like to have a label for a mental illness that doesn't go away? Instead of talking about a full recovery for you or getting rid of something, it's more learning to [00:24:00] manage it. What's that like for you and then what do you do in the long run to manage it?
Ana: Initially, of course, I was upset. I was like, "This sucks." [crosstalk]
Ellie: This is chaotic and scary.
Ana: Once again that idea of at any point, it can slip into chaos. At any point, I could definitely be in another episode. I know that I have been through a lot and I have learned a lot most skills along the way, [00:24:30] and I can come back. I know what works, what medications work, I know what does not work. [laughs] I feel as though yes, this is definitely frustrating that I will live with this. In a strange way, it's also like, "This is who I am."
Ellie: Tell me what your career goals are now, now that you're not doing med school?
Ana: When I left medical school I went right into social work because I thought that it would be tangentially related to the healthcare field. Right now I am in graduate school for social work with the intention of working for nonprofits, and doing grant writing and development, [00:25:30] and just really trying to ensure that people who are doing good work will have the financial sustainability to keep doing that.
Throughout recovery, I realized that I am not a fan of shallow relationships. I do not want that. I have no time for that. I'm always going to tell people that mental health and mental illness plays a big role in my life because I think it plays a big role in everyone's life. [00:26:00] We all have a mind and so we all have to take care of it. I enjoy talking about it and as a result, I enjoy sharing my story quite a bit, mainly because I want to hear other people's stories too. I know I'm not alone.
Ellie: Ana is most definitely not alone. While you and I may or may not deal with the disorder [00:26:30] like bipolar we definitely deal with the shame that played such a destructive role in Ana's story. We can make the same choices she made and continues to make. Acknowledge the thought, let it go, and work to build a support system to keep us healthy. It's the bedrock of mental hygiene. These skills can help all of us find a way in the inevitable heavy times of life.
Let me just add that if you've really resonated with Ana's story and can use a professional lifeline like she [00:27:00] found in Dr. Stone, don't hesitate. It's not worth giving up on your life when there are options to help you. For a free consultation with a master's level clinician at Pathlight Behavioral Health, call 877 411 9578 or visit insightbhc.com.
Mental Note is produced by Sam Pike, it's created in collaboration with Eating Recovery Center and Pathlight Behavioral Health. Find us at www.mentalnotepodcast.com [00:27:30] While you're there go ahead and sign up for our email newsletter and check out our past episodes. Oh, and if you're feeling extra generous, please leave us a review on iTunes. Those go a long way in helping others find this show. I'm Ellie Pike, till next time.
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